In recent years, health plans and providers seeking to provide culturally competent care and services to individuals from diverse backgrounds have incorporated community health workers (CHWs) in interdisciplinary care teams.1 CHWs – also known as promotoras de salud, community health representatives, community health advisors, or health navigators – are frontline public health workers who have an ethnic, linguistic, cultural, or experiential connection with the population they serve because they come from a similar background, speak the same language, or live in the same community as their clients.2 CHWs draw on a wide range of skills, as well as knowledge of the community and their rapport with the client, to provide individualized, culturally appropriate, and highly personal help to members or clients. As a result, CHWs often serve as a bridge between members and the services they need.
CHWs’ linguistic and cultural alignment with the populations they serve may be particularly useful for providers and plans serving individuals dually eligible for Medicare and Medicaid. In 2014, approximately 1.8 million dually eligible individuals had limited English proficiency3, and in 2016, 37 percent of dually eligible beneficiaries were members of racial or ethnic minority groups.4 Dually eligible individuals on average also have lower incomes and more complex health conditions than enrollees in Medicare or Medicaid alone, and higher levels of unmet health care and health-related social needs.5,6,7 CHWs can draw on their knowledge of the community to connect dually eligible individuals with needed resources.
This series of briefs describes:
Skills and techniques successful CHWs use to meet the needs of dually eligible individuals;
Organizational components necessary for successful CHW programs; and
- Promising practices for recruiting and training CHWs.
Providers and plans may find this information useful if they are considering hiring, or have recently hired, CHWs to coordinate care and address unmet health and social needs of dually eligible individuals.
1 Snyder, J. (2016). Community Health Workers: Roles and Opportunities in Health Care Delivery System Reform. Retrieved from https://aspe.hhs.gov/system/files/pdf/168956/CHWPolicy.pdf
2 Centers for Disease Control and Prevention (2016). State Law Fact Sheet: A Summary of State Community Health Worker Laws. Retrieved from https://www.cdc.gov/dhdsp/pubs/docs/SLFS-Summary-State-CHW-Laws.pdf
3 Proctor, K., Wilson-Frederick, S. M., & Haffer, S. C. (2018, May 1). The Limited English Proficient Population: Describing Medicare, Medicaid, and Dual Beneficiaries. Retrieved from https://www.liebertpub.com/doi/full/10.1089/heq.2017.0036
4 Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission (2018). Data Book:Beneficiaries Dually Eligible for Medicare and Medicaid. Retrieved from https://www.macpac.gov/wp-content/uploads/2020/07/Data-Book-Beneficiaries-Dually-Eligible-for-Medicare-and-Medicaid-January-2018.pdf
5 Kaiser Family Foundation (2018). Featured Dual Eligible Resources. Retrieved from https://www.kff.org/tag/dual-eligible/
6 Center for Health Care Strategies (2009, July). Supporting Integrated Care for Dual Eligibles. Retrieved from https://www.chcs.org/media/Integrated_Care_Policy_Brief.pdf
7 Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission (2018). Retrieved from https://www.macpac.gov/wp-content/uploads/2020/07/Data-Book-Beneficiaries-Dually-Eligible-for-Medicare-and-Medicaid-January-2018.pdf