By 8 a.m. on a recent Saturday, Vuela for Health’s office in Denver’s Cole neighborhood was already buzzing with people there to learn if they should be worried about their hearts.
The Colorado Prevention Center’s Community Heart Health Actions for Latinos At-Risk, or CHARLAR, program targets Spanish speakers in the Denver area. It involves a baseline screening of risk factors for heart disease and diabetes, weekly classes about ways to reduce risk, and a follow-up to measure progress at the end of the 12-week program.
Diane Medina, a community health worker who has been involved in CHARLAR for 18 years, was taking pinprick blood samples that Saturday to test for high blood sugar and cholesterol. She said the staff teaching the classes are “relentless” in recruiting people and making sure they show up for all 11 sessions, and that most participants see benefits they can build on.
They complete the cycle with three different cohorts each year, many of them people who came to Vuela for some other service or saw a presentation about the program at church.
“When (other programs) tell me they can’t find participants, I don’t believe it,” she said. “It’s that relationship building that’s so key.”
Programs like CHARLAR rely on grants, which organizations have to apply for every few years. A bill in the Colorado Senate would attempt to give them some increased stability by allowing Medicaid to pay for community health workers’ services. The hope is that money spent now on the workers can improve Medicaid recipients’ health and head off expensive hospitalizations later.
Senate Bill 23-2 would require the Colorado Department of Health Care Policy and Financing to ask the federal Centers for Medicare and Medicaid Services for permission to cover services by community health workers, after a public input process. Fifteen states have some framework for covering community health workers, though they vary in the qualifications they require and the services they allow the workers to perform.
Diana Pineda, founder and CEO of Vuela, said only about 30% of their clients are covered by Medicaid, since some earn too much and others are undocumented. Government and philanthropic grants would still be vital to serve those populations, but Medicaid funding would offer some stability and recognition of the role community health workers play in the health system, she said.
“An organization like us is always depending on finding a grant,” she said.
“It’s a win-win”
The bill leaves it to the Department of Health Care Policy and Financing to determine what qualifications community health workers would need, what services Medicaid might cover and how they would be reimbursed. The category could include navigators, who help patients find resources to manage their care, as well as others like patient educators.
The fiscal note estimated about 1,000 people working in Colorado might qualify and opt to provide services through Medicaid in the first year, at a rate of about $39 per hour. Based on those estimates, it would cost about $19.5 million in state funds and $43.2 million in federal money in the first year.
Sen. Kyle Mullica, an Adams County Democrat, said he expects future versions of the bill will include more guidelines about the types of services covered, and consequently have a lower potential price tag. It also will be amended to require community health workers to register and show the training they’ve completed, he said.
About 150 people have voluntarily registered as patient navigators, but it’s not clear how many opted not to register with the state, let alone how many people are working in related fields, like patient education.
The goal is to create a stable way of paying the workers who provide health education and help patients find resources outside the clinic, Mullica said. Some hospitals and larger practices that receive incentives for keeping patients healthy pay for community health workers themselves, but smaller clinics often have to rely on grant funding that lasts only a few years.
“It’ll be good for the patients as well, knowing there are going to be these people here who are a stable thing,” he said. “It’s a win-win.”
Financial benefits
Return on investment for community health worker programs varies by the location, the type of work and the target population.
MHP Salud, which runs community health worker programs in Texas’s Rio Grande Valley, estimated a diabetes management program saved about $1.09 for every dollar spent, while a program to increase cancer screenings saved $3.16 per dollar. A program focused on low-income adults with at least two chronic conditions in Pennsylvania saved about $2.47 per dollar.
A study of people who returned for follow-ups in the CHARLAR program found small, but statistically significant, reductions in blood pressure, cholesterol and blood sugar.
Pineda said many of the people they recruit into the program weren’t connected to health care, and had no idea if they might be at risk for heart disease. The navigators and promotoras — community health workers who mostly work outside clinic walls in Latino neighborhoods — can help them make the most of the limited time they have with doctors and get them comfortable using spaces they weren’t sure would be friendly to them, like the city’s recreation centers, she said.
“It’s not changing the whole system. It’s using the system we have the best way,” she said.
Joel (pronounced Ho-el) Blanco-Aguirre, a navigator with CPC Community Health, normally works one-on-one with people at elevated risk for heart disease, but was helping CHARLAR participants to understand their test results at the February event.
He said community health workers from the same culture can speak to participants in a way that gets through; for example, they know many people won’t want to talk about anxiety and depression, but feel comfortable discussing how “stress” affects their health.
“Everybody knows what that is,” he said.
Blanco-Aguirre said that most people won’t decide to seek out individual help from him after completing the classes, but the program is successful in connecting participants to primary care providers and to resources they might not have known about or been comfortable seeking out.
“They make my job easier,” he said.
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