An established pillar of Colorado’s health care system received powerful additional support in late April with bipartisan Colorado passage SB23-002. The bill will allow Medicaid reimbursement for certain services provided by community health workers (CHWs), which help connect patients to vital health and community services, provide education, and reduce barriers to care, among other activities. CHWs often have a variety of titles, including healthcare navigators and lay healthcare professionals.
Colorado SB23-002 provides that by July 1, 2024, the Colorado Department of Healthcare Policy and Financing (HCPF) will submit a plan to the Centers for Medicare and Medicaid Services (CMS) outlining the specific CHW services that will be covered by Medicaid and the rate refund for them. Later this year, the HCPF will hold public hearings to receive input from CHWs, public health agencies and other “stakeholders” on the CHW services to be covered, their qualifications, roles and other points needed for CMS submission.
Representatives from the Colorado School of Public Health provided lawmakers with important data to help them consider the bill, which Gov. Jared Polis signed into law on May 10. for disadvantaged patients, contributing to cost-effective care and improving patient outcomes.
The information helped the bill gain bipartisan support from lawmakers representing not only urban communities of color and cities along the Front Range with large numbers of working poor but also small rural and frontier towns, he said. Andrea (Andi) Dwyer, director of the Colorado Cancer Screening Program and senior professional research assistant in the ColoradoSPH Department of Community and Behavioral Health.
“We were able to show the investment in the program and the returns,” Dwyer said. “This has put us in a good position to help leverage and educate people about the impact of the bill.”
What is old is new
“Community health workers are not new and have long been used by community health centers and organizations,” said Patricia Valverde, PhD, MPH, director of the Patient Navigator Training Collaborative at ColoradoSPH’s Center for Public Health Practice. clinical assistant professor of community and behavioral health and interim director of the Latino Research and Policy Center at ColoradoSPH. “They support patients who have potential challenges that make it difficult to access and complete treatments and self-manage their care,” she added. Assistance includes connecting patients to transportation, financial assistance, support groups, behavioral health, and medical interpretation. Valverde leads longstanding patient navigation and community health worker training (PNCT), a key pipeline for CHWs. She said the collaboration has trained more than 2,000 patient navigators since its inception. That information was vital to the bill’s drafters who wanted to avoid creating new systems and processes for the CMS repayment plan.
“We have demonstrated that we have an existing process and infrastructure available for training navigators and other CHWs, and our state has a system in place to assess their skills,” Valverde said.
Additionally, Valverde collaborated with DrPH student Shenazar (Shane) Esmundo to compile the growing body of peer-reviewed literature evaluating the efficacy of CHWs. Such information helped educate lawmakers, not only about the importance of CHWs, but also that they no longer needed to require more data to support their role in the health care system.
Demonstrate the efficacy of CHW
“Patient navigators and other community health professionals are sometimes the only interveners who have truly demonstrated impact in reducing barriers to accessing care and improving equitable approaches,” Dwyer said.
Testifying in support of the bill, Dwyer pointed to statistics supporting the patient navigators’ success in guiding approximately 36,000 patients statewide to colorectal cancer screenings:
· 92% of patients present for examinations
· 98% of exams completed
· More than 250 types of cancer have been detected
· It is estimated that more than 750 cancers have been prevented through the detection of advanced adenomas
· Savings to the health care system have been estimated at $15 million
Navigators also help improve care by freeing up nurses, doctors and other caregivers “as effectively as possible,” Dwyer added.
“Self [patient navigation] were a pill or [medical] device, that would have been covered years ago,” he said.
A measure of financial stability, but more work to do
Dwyer and Valverde noted that SB23-002 is particularly important as government and grant funding for CHWs has decreased in recent years.
“The bill finally provides at least one channel for financial stability of positions,” Valverde said. “If we hadn’t done anything, at some point we would really struggle to hold on [them] okay.”
Dwyer stressed that the bill’s passage is “just one hurdle” in a broader effort to make CHWs a fixture of the health care system. The next challenge is to expand reimbursement for CHW to private payers and Medicare, she said. However, this will require keeping the concept of patient navigation at the forefront of health care discussions, an effort he has been working on to address the Patient Navigation Sustainability Assessment Tool, developed by ColoradoSPH and the National Roundtable on Health. colorectal cancer of the American Cancer Society.
“If we don’t find a way to showcase our value and impact, have champions, engage communities and continue to nurture politics, those things don’t stick,” Dwyer said.
Written by Tyler Smith for the Colorado School of Public Health.
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Colorado School of Public Health
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