Community health workers: A bridge to health literacy and patient outcomes

Health literacy is imperative to improving the health and wellbeing of people in our communities and reducing disparities among vulnerable populations. But with nearly 36% of the U.S. adult population having low health literacy, there's much work to be done. Community health workers (CHWs) have proven to be a significant resource as they have a deep understanding of the communities they serve and can improve the health literacy of individuals by addressing their clinical and non-clinical needs.

What role do CHWs play?

Community health workers are typically unlicensed healthcare professionals called upon to serve as a liaison between a healthcare organization and patient. Among their many roles, they support and motivate individuals in their self-management of disease, provide culturally appropriate health promotion and education, conduct follow-up care and become a trusted partner. In fact, CHWs build relationships from which patients may disclose information that they may not tell anyone else. Screening for unmet patients' social needs such as transportation, housing, isolation, language barriers and then connecting them to community-based services and resources is a vital part of the CHW's role.

One CHW I spoke with remarked that he helped a newly diagnosed, Spanish-speaking diabetic patient overcome apprehension of eating due to fear of diabetic complications. The language barrier, coupled with the patient's limited health literacy, resulted in the patient not understanding what the physicians and nurses were saying about diabetes and he was afraid to ask. Not to mention, the patient's access to food was limited. Through the relationship, the CHW, who spoke Spanish, changed the outcome and positively impacted the patient's health literacy.

There's no doubt that CHWs make a difference. So, what's stopping the widespread use of CHWs in all healthcare settings? Barriers to using CHWs can include:

Unrecognized potential: Many healthcare organizations may be unfamiliar with the role of the CHW aside from making referrals. The CHW has a skillset and ability to connect with patients on a deeper and broader level that many other healthcare professionals do not.

Training: Certification processes and training for CHWs vary across the country. Nationwide, there is a lack of standardization of practices, core competencies and performance measures that make credentialing the CHW difficult.

Integration with the healthcare team: Because of the uniqueness of the CHW role, healthcare teams may struggle with knowing how and where to integrate them. Ambiguity could lead to resorting back to familiar care-team models whereby CHWs are siloed into seeing patients based solely on referrals.

Funding: CHW positions are often grant-funded. This unstable funding source creates issues with retention of employees and sustainability of any progress made with individual patients and in the community at-large. Many health systems have intentions on fully funding the CHW position; however, budget restraints and other economic factors make it difficult to sustain the CHW program over time.

But these barriers can be overcome. Here's how healthcare organizations can take steps to establish and ensure successful CHW programs:

Establish clarity: Write a policy that defines the CHW's role, required skills and responsibilities in your organization and the community. Be mindful that the more community involvement the CHW can have the better. Align the policy with state-based requirements, since each state varies in the definition, training, certification and reimbursement for CHWs. These definitions will help the healthcare team know how best to use the CHW and enable licensed staff such as physicians, nurses or social workers to work at the top of their licensure. Establishing competencies also will assist in CHW retention and career ladder advancement opportunities within your organization.

Be a visionary: Utilize the CHW with patient populations that historically have been difficult to reach. The CHWs can lean on their unique ability to build trust and rapport when working one-on-one with individuals seeking to improve their health but may not know how to do so. The relationship can branch beyond the provider's office into the community, where the CHW can help patients obtain necessary resources, identify free and easy-to-access amenities such as recreational areas, and navigate accessibility to grocery stores or food pantries.

Secure funding: Determine early how your organization will pay the CHW beyond the expiration of grants. Fee-for-service models have shown promise and rely on good documentation to support billing codes. Under the 2024 Physician Fee Schedule passed by the Centers for Medicare & Medicaid Services, services performed by the CHW through community health integration, social determinants of health risk assessments and principal illness navigation are reimbursable. Alternative payment models such as pay-for-performance models or shared savings programs also may provide incentives to incorporating the CHW.

Healthy People 2030 — a U.S. Department of Health and Human Services initiative that helps individuals, organizations and communities committed to improving health and well-being address public health priorities through national objectives — understands that improving the health literacy of communities is imperative. But the onus is on us as healthcare organizations. Help broadcast the good news about how CHWs can significantly impact health literacy and support these professionals to do what they do best in the bridging the gap with patients.

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