In a new article in the New England Journal of Medicine, Dave A. Chokshi of the Department of Veterans Affairs and Professor Prabhjot Singh of Columbia SIPA, the Earth Institute, and Mount Sinai Hospital suggest that global lessons about how to deliver healthcare in community settings should be available across America. You can find the article here.
The common link they present is a new initiative centered on the work of Community Health Workers (CHWs), who comprise networks of full-time, rapidly trained, mobile equipped and community-based workers who are transforming healthcare delivery worldwide through their local knowledge and practice.
In order to ensure that CHWs in America are a source of high-quality new jobs and improved healthcare delivery, Singh and Chokshi provide five recommendations. These include improving the evidence base for this professional group, promoting CHWs as a job engine for health in communities, creating recognized certification standards, covering their services by medicare/medicaid and finding insurance companies and hospital providers to support their development.
As outlined in the NEJM article, Singh’s team is working closely with three models of CHW systems:
- CHWs as extensions of hospitals or clinic systems,
- community-based nonprofit organizations
- CHW management entities that link community and clinic.
In each of these settings, CHWs in the US can focus on early risk detection, self-management & chronic care support, as well as primary care integration, all while remaining community advocates. The program team also works with healthcare systems that are preparing to use CHWs in an effort to reorganize their care models from episodic encounters with patients towards long-term relationships that focus on prevention and appropriate use of medical care.
The potential of CHWs goes beyond an incremental improvement in healthcare delivery. They represent a welcome shift towards enabling communities to be more responsible for their own health while lighting the way for a new frontier in medicine: one that moves from hospital and clinic to neighborhoods and homes.