September 30th, 2014
The health system in the United States is undergoing transformative changes at the local, state, and national levels. A significant part of this change is the estimated 20 million-plus people that have gained health coverage, many for the first time, through the Affordable Care Act (ACA). In Kentucky, more than 520,000 people are newly insured in either Medicaid or a qualified (private) health plan through the health benefit exchange, kynect. (I work at the Foundation for a Healthy Kentucky.)
Lack of health coverage is a significant barrier to getting needed and timely care. Still, as others’ research has shown, health coverage does not equal access to care. Kentucky has been enormously successful in enrolling individuals and families into public and private insurance. Now, the state, local communities, and a variety of organizations are busy formulating strategies to make sure that this new coverage translates to timely access to high-quality care.
States and communities still have work to do, including assuring that there is an adequate health care work force—that is, adequate in quantity and types of providers; assisting people with navigating a complex health system; providing education to increase health literacy; incorporating prevention and other population-level approaches into a health system that thus far has been focused on “sick care”; being responsive to cultural and linguistic needs of communities; addressing the important role that socioeconomic factors play in health and health outcomes; and controlling (or decreasing) health care costs.
One strategy that can address all of the challenges above, and has been used successfully around the world, is bringing community health workers (CHWs) into the mix—whether as paid workers or volunteers. CHWs are also known as lay health workers or promotora/os among other names. A CHW is defined by the American Public Health Association as a “frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served.” CHWs are members of the communities they serve, as well as the clinical care or public health teams, and often work in community-based organizations. This trust-based relationship between the CHW and community members helps to incorporate social and cultural dimensions that can break down barriers to access and also improve quality and decrease costs. Read the rest of this entry »