Community Health Workers: Credentialing and New Opportunities

Transcription

1 Community Health Workers: Credentialing and New Opportunities Carl H. Rush, MRP Project on CHW Policy & Practice, U. of Texas Institute for Health Policy ORHP Grantee Webinar March 13, 2014

2 Today s topics Definitions: getting on the same page CHW credentialing: What is it? Good thing? Bad thing? What does it take? New Medicaid preventive services rules Opportunity to sustain CHWs? What will it take?

3 3

4 What s your definition of CHW?

5 CHW Roles And Functions (1) National Community Health Advisor Study (1998): Cultural mediation between communities and health and human services system Providing culturally appropriate health education and information Assuring people get the services they need Informal counseling and social support 5

6 CHW Roles And Functions (2) Advocating for individual and community needs Providing direct services, mainly in remote areas, and meeting basic needs Building individual and community capacity 6 s/pdf/publications/cahsummaryall.pdf

7 Pro-active Vs. Responsive Roles Many stakeholders think of CHWs in limited terms, mainly outreach (proactive) Many CHWs also are assigned to patients or receive referrals (responsive) Roles touch entire continuum of care 7

8 What Is Distinctive About CHWs? (1) Do not provide clinical care Generally do not hold another professional license Expertise is based on shared culture and life experience with people served 8

9 What Is Distinctive About CHWs? (2) Rely on relationships and trust more than on clinical expertise Relate to community members as peers rather than purely as clients Can achieve certain results that other professionals can't (or won't) 9

10 Professionalization of CHWs Language is changing from the CHW model and CHW programs to CHWs as part of the system CHWs as front-line public health workers and members of clinical care teams Requires recognizing and valuing their unique expertise they are not clinicians

11 Is professionalizing a good thing? Will CHWs lose touch? Will employers kill the goose? Can CHWs balance accountability to community and employer institutions? Should they become more like existing professions? What about volunteers? Community membership as a qualification: who is a CHW?

12 What is Credentialing? A process of documenting a person s qualifications to perform the duties of an occupation or profession

13 Is credentialing a good thing? PRO: Respect and recognition Clarification of boundaries with other professions Standards needed for mainstream funding

14 Is credentialing a good thing? CON: Create barriers to entry for good people? Will it medicalize the field? Will the CHW become more of a career and less of a calling?

15 Types of Credentials Registration Certification Permit License (MA, VA, NY: licensing not needed)

16 Certification Declaration by issuing authority that an individual has necessary skills NOT the same as an educational certificate of completion Issuing authority: government, educational, association or employerbased; does NOT have to be the State govt.

17 Basic Components of a CHW Credentialing Program Definition of CHW Scope of practice: boundaries with other professions Eligibility and application process Procedure for assessing applicant's skills Administrative home: $ Continuing education requirement Procedures to renew, revoke/expire

18 Where are CHWs credentialed? OH, TX have the only broadly-based certification systems IN, AK have certification tied to employment in specific programs MN requires standard training to become Medicaid provider MA has convened a credentialing commission Initiatives underway OR, NM Formal proposals developed in NY, FL

19 A responsive certification system Multiple paths to entry, including based on experience ( grandfathering ) Required education available in familiar, accessible settings Teach using appropriate methods (adult/popular education) Easy access to CEUs, distance learning Respect volunteer CHWs!

20 Discussion

21 Sustainability options for CHWs 3 rd party payers New payment structures Internal financing

22 Current payer interest in CHWs Hot-spotters high utilizers Chronic disease management MCH/birth outcomes Cancer screening and navigation Patient-centered medical homes Care transitions

23 Medicaid Breakthru: Preventive Services 78 FR 135 p : 7/15/13 (effective Jan. 2014) Diagnostic, screening, preventive, and rehabilitative service Preventive services means services recommended by a physician or other licensed practitioner (previously read provided by ) Brings rules into conformance with ACA Commentary clearly reflects interest in funding services by CHWs and other non-licensed providers Payment for CHW services will no longer need to be treated as admin costs 23

24 Requirements to Take Advantage of Medicaid Rule Change Requires State Plan Amendment (in a few states this requires legislative authorization) Must specify what non-licensed occupations are covered and qualifications (skill requirements) not necessarily certification Must specify what services will be paid for (CPT codes) and which Medicaid recipients are eligible Must specify rates of payment and payment mechanism (FFS, MCO, bundled payment etc.) 24

25 Relating the Opportunity to the Bigger Picture Does your state already have policies in place around CHWs? Is there a policy initiative underway? Can this opportunity trigger action on broader policy issues? Can you redirect fast-track attention on this opportunity toward those broader policy issues? Is there a role for non-healthcare organizations as employers of CHWs? What about prevention for those not eligible for Medicaid? 25

26 Updated 3/11/ Community Resources LLC

27 Common Elements in State CHW Policy Initiatives Gathering CHW workforce data Convening leadership and champions General education/awareness CHW professional association/network Agreement on standards and credentialing Strategies for sustainable CHW roles 27

28 Discussion

29 Contact Information Carl H. Rush, MRP