Best Practices: Community Health

Workers and Positive Impact on Community Change

Grassroots impacts of Community Health Workers, Promotoras and Lay

Health Workers in relation to the upcoming roles of Patient Navigators

with the Affordable Care Act.

Arizona Rural Women’s Health Network Members• Eastern Arizona Area Health

Education Center• Greater Valley Arizona Area

Health Education Center• Northern Arizona Area Health

Education Center• Western Arizona Area Health

Education Center• Mogollon Health Alliance• Time Out, Incorporated

• Arizona Department of Health Services• Mariposa Community Health

Center• Arizona Alliance for Community

Health Centers• Arizona Office of Rural Health-

University of Arizona-MEZCOPH• Payson Chapter Amnesty

International

The Role of The Community Health Worker or Promotora

Community Health Workers (CHWs) are frontline public health workers who are trusted members of and/or have an unusually close

understanding of the community served. This trusting relationship enables CHWs to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to

services and improve the quality and cultural competence of service delivery. CHWs also build individual and community capacity by

increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal

counseling, social support and advocacy. (APHA)

The Promotora Model

Spanish word for “promoter” and in this context also can refer to community health workers.

Promotoras live in the communities in which they work. They are the

knowledge keepers for that community. They are not usually formally educated, but serve as a wealthy of knowledge for those

people needing to access services in the community. They are trusted advisors, educators and able to

reach those in underserved areas.

The Definition of the CHW or Promotora can be broad- however is built on these

core definitions:

1. Bridging and providing cultural mediation between communities and health and social service systems2. Providing culturally appropriate health education and information3. Ensuring people get services they need

4. Providing informal counseling and social support5. Advocating for individual and community needs6. Providing direct service, such as basic first aid and administering health screening tests7. Building individual and community capacity

Why is the Promotora/CHW/CHA Model Considered a Best Practice?

The National Community Health Advisor Study, conducted by the University of Arizona, found an array of benefits associated with CHA outreach & education services in underserved communities, such as decreases in ER visits, a reduction in the length of hospital stays, and fewer medical complications when patients do receive medical attention. Because CHA outreach focuses on the individual, services are provided in a cost-effective and culturally sensitive manner that eliminates many barriers that prevent some from obtaining medical care. As a result, a greater sense of trust develops between the community and the formal health care system.

Community Capacity Opportunities

Communities can benefits from new leadership. CHWs & Promotoras are usually very well respected community members and can help with capacity building.

The Promotoras/CHWs are positive representatives of their respective agencies and will act as advocates for the community.

Both CHWs & Promotoras are well versed in the assets and needs of their communities.

Amazing Community Health Worker and Promotora Work here in Arizona!

ACA: Marketplace - Patient Navigators

• Each Marketplace is required to have at least two (2) types of entities serve as Navigators- one (1) must be a community and consumer focused non-profit• Must be trained to ensure they have expertise in the needs of

underserved and vulnerable populations (e.g. rural, people living with HIV/AIDS)• Navigator grantees could include individuals and organizations

that often target their outreach to specific ethnic, geographic or other communities although all Navigators should have ability to help any individual who seeks assistance

Navigator Eligibility

• Eligible entities:• Self employed individuals• Public and private entities including non-profit

organizations, tribes and tribal organizations, unions, chambers of commerce, etc.

• Ineligible entities:• Health insurance issuers and their subsidiaries• Associations that include members of, or lobbies on behalf

of, insurance industry• Recipients of any direct or indirect consideration from

health insurance issuer in connection with enrollment

Navigator Program Management• In the Federal Marketplace- HHS funds and awards funding for Navigator grants•States choosing to build their own Marketplace will build their own Navigator programs including awarding and overseeing grants, developing standards and ensuring adherence to programmatic requirements

Non- Navigator Assistance Personnel

(In-Person Assistance Personnel)•A “non-Navigator assistance program” is a

program established to fulfill consumer assistance, education and outreach functions.•HHS does not anticipate operating non-Navigator assistance programs in the FFM.

CACs in the Marketplace• Certified Application Counselor.

What does this mean to us and those we serve?

• States building own Marketplace- Navigator and CAC, but may choose whether or not to have a non-Navigator assistance program.• States working with CMS- Must have a Navigator, non-Navigator

assistance program and a CAC program.• The Federal Marketplace- Navigator program, CAC program, but is not

anticipated to have non-Navigator assistance personnel.

Get the latest resources to help people apply, enroll and get coverage at- Marketplace.cms.gov

Thank you!

Kim Zill, MSNetwork DirectorArizona Rural Women’s Health Networkkimberlyz@aachc.org

 

700 E. Jefferson St. | Suite 100 | Phoenix, AZ 85034                                                  Phone: 602-288-7544 | Fax: 602-252-3620