Policy is Destiny in Community Health: How Policy Decisions Drive Local Community Health Worker Employment.

• In Event: The Community Health Worker (CHW) Initiative: Responsive Engagement, Community Capacity and Emergent Health

Abstract

The most obvious, and still too-often overlooked, policy decision effecting our health is about how and who gets paid on a healthcare team. The fee-for-service model embodied in billing codes also enshrines roles for different sorts of expertise on the healthcare team. The technology of billing drives the options for healthcare delivery, and has been especially damaging for Community Health Workers (CHWs). The CHW plays a marginal role in these billing schemes, when they show up at all, which is often at odds with their perceived importance in providing a bridge to the community. Several competing policy approaches to CHWs have emerged in the context of the larger healthcare industry’s various efforts to modify the fundamental framing of fee-for-service, but each still depends on a pyramid-shaped deployment of expertise. What policies would support the CHWs as emergent voice, capable of framing research agendas and shaping broad community health programs? Can a schema for shared reimbursement or pooled resources be created within existing healthcare structures? Would that change allow the CHWs to provide an independent voice as advocates for the community’s most vulnerable populations?

Author

• Abel Chacko, State of Texas Senate Committee on Health Policy