Drs Anita Makkenchery and Brandy Farrar: The Role of Community Health Workers in a Postpandemic World

March 28, 2021

Anita Makkenchery, MD, MPH, and Brandy Farrar, PhD, discuss the potential for community health workers to become a regular part of the health care system in a post-COVID-19 world.

Anita Makkenchery, MD, MPH, a research associate in the Quality Improvement and Innovation Division at IMPAQ International, and Brandy Farrar, PhD, a principal research associate in IMPAQ’s Health division, presented results from their study on community health workers in a poster at the Academy Health 2021 National Health Policy Conference.


What can be done to ensure that there is adequate funding available for CHW (community health worker) programs?

Makkenchery: I think it's a tough question to answer just because funds come from private organizations, the government, through grants. So, there isn't a standardized funding stream for community health workers. I think that is an important area to clear up and create a process for in order to integrate community health workers in the community properly and train them as they need to be trained, and not that just assume [that because] they're from the community that it's easy to get them to work or that their work isn't valuable. We really need to consider coming up with a funding stream and process so that they are compensated appropriately.

Farrar: Yeah, and I think we're seeing some sustainable traction in the Medicaid space in terms of coverage for community health workers. I think maybe 20 or so states do that systematically. Also, we're seeing some gain momentum around value based care arrangements, where plans are entering both in the public and private space and recognizing that community health workers can help achieve those goals and better outcomes at lower costs. So, integrating them in the care teams, we are seeing a lot of good return on investment related to that, that then, can ultimately sustain their living wage employment, as Anita was discussing. I think we're starting to see some emerging practices that may be sustainable beyond short-term programs, grants, and relying on philanthropy or volunteerism, which is also something that happens a lot. But I don't think that quite yet we've seen anything widespread that suggests that there's going to be sustainable funding for this role.

What areas do you think community health workers could have in health care once the COVID-19 pandemic eases?

Farrar: So, I think what's exciting about this is [the idea of] "never letting a crisis go to waste." I keep thinking about that quote, which is sort of horrible, but not in some ways, in terms of thinking about how changes made in haste because of emergencies are able to sustain and ultimately improve the system longer term. I think this could be an example of that, where the relationships that community health workers are building during COVID-19, specific to addressing the needs of the pandemic, can endure longer term, in terms of being those barriers between communities, public health, health care, and the organizations that they're working for.

So, we talked about how they might influence more systemic issues. I think giving them a role and recommending policy and systems changes could be another sustainable path long turn. Maybe folks who are engaging with health care for the first time because they've had to or because they were encouraged to because of a community health worker are going to experience this and think, "Oh, that's not as bad as I thought it would be." So, the next time something comes around where they're not feeling well or someone makes a recommendation for a preventative service that they need, they'll feel more comfortable going into the health care system. There is a path for this to really improve longer term, particularly in vulnerable populations, once the pandemic ends.

Makkenchery: Yeah, I definitely agree with that. The pandemic highlighted the gaps in our health care system and it doesn't mean that those gaps will go away just because the pandemic has become much more manageable. So, I think this is a prime time to continue to incorporate community health workers. And there is an interest in people becoming a community health worker, as well. That just means we have more resources. So, we need to take advantage of those direct community resources [and have them] in schools, go door-to-door, and go to different places of employment. As Brandy said, I think this is kind of advantageous, because now we can create a sustainable framework for community health workers.