Many public health experts are advocating for rapidly scaling up the use of community health workers as part of the COVID response. But they point out that to do this effectively, CMS and states need standards for the community health worker profession to ensure quality and serve as guardrails for federal funding. The National Committee for Quality Assurance (NCQA), in partnership with the Penn Center for Community Health Workers, is leading a multi-stakeholder effort to create evidence-informed standards for the profession.
In a May 15 blog post on the Milbank Memorial Fund website, Shreya Kangovi, M.D., executive director of the Penn Center for Community Health Workers, and Margaret O’Kane, president of the NCQA, described how NCQA is convening an advisory panel composed of members from organizations like the National Association of Community Health Workers, Kaiser Permanente, and the Johns Hopkins University that is reviewing the global and domestic experience and implementation science on community health workers and developing standards.
The advisory board will include a number of grassroots community health workers. In addition, a reactor panel of patients and community health workers will review draft standards and provide feedback.
These standards will address domains that appear to be associated with high-quality programs:
• The recruitment and retention of community health workers who have shared life experiences with patients and attributes such as empathy;
• Compensation to ensure workers are paid a living wage with benefits;
• Work practices that support comprehensive, longitudinal relationships with patients;
• Enabling infrastructure including training, supportive supervision, performance metrics, and reasonable caseloads; and
• Protection from workplace hazards ranging from neighborhood violence to global pandemics.
The standards, which should be released by the fall, could be used by state health departments, Medicare, and Medicaid, as well as private health plans as they are determining which health providers and community-based organizations that employ community health workers to include in their networks. The standards can also be used by community health workers to advocate for themselves.
Kangovi, and O’Kane noted that there are risks associated with standards development. “In health care, the concept of standards is often associated with training, certification, and licensure. This can often evolve into rigid definitions of scope of practice and narrow billing codes for service and episodic reimbursement. Several states have adopted the approach of certifying community health workers based on their completion of an approved training course; however, a recent evidence review by the Agency for Healthcare Research and Quality suggests that these training-based certifications do little to improve quality. In fact, these certification requirements may have the unintended consequence of weeding out ‘natural helpers’ who may be nervous about standardized testing or unable to afford courses or certification fees.”
They added that the proposed NCQA standards are not focused on how community health workers are trained or intended to generate an itemized scope of practice. “Rather the goal is to provide simple, evidence-informed guardrails for the systems in which community health workers function, including hiring of authentic community members and the preservation of holistic, grassroots work practices. We hope that a systems approach developed by an advisory board composed mainly of community health workers will guard against over-professionalization or coopting of the workforce.”
