Opportunities in State Planning to Promote Employing CHWs
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Opportunities in state planning to promote employing CHWS include:
- Standards for patient-centered medical homes and community health teams
- New models for global payment, pay for performance, and accountable care organizations
- Rules for medical loss ratios
- State Innovation Models (CMMI)
With implementation of expanded health insurance coverage under the ACA come many opportunities to advocate for CHW services. Many sections of the ACA require state-level planning for implementation, and this phase is already under way in most states. This planning process affords an excellent opportunity for discussing potential CHW roles. We have mentioned initiatives to reduce hospital readmissions and the community health teams serving medical homes, but other opportunities exist.
Most states are looking at new models for global payment, pay for performance, and accountable care organizations. In the ongoing discussion about regulating health insurance companies, debate continues on requirements for minimal levels of “medical loss ratios,” or the percentage of insurance premiums that are paid out in medical costs. Part of this debate is whether to classify the cost of efforts to improve the quality of health care as provision of care or as administrative services. CHW services may well fall within the rubric of quality improvement initiatives. Finally, the entire range of benefits to be required from health insurance plans, but especially preventive care, is still under debate. There may be an opportunity to inject the role of CHWs into these discussions.
One major program under the Center for Medicare and Medicaid Innovation, the State Innovation Models, has stimulated state-level health care reform planning in more than half the states. More than half the state Health Care Improvement Plans developed or tested under this program have involved significant CHW elements.