A new policy paper from Duke-Margolis Center for Health Policy, UNC Center for Health Equity Research and Duke Clinical Research Institute delivers policy recommendations to enhance and prioritize Community Health Worker (CHW) models into existing health care transformation reforms to address health inequities in the U.S.

In a review of 16 National Institutes of Health-funded, Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) projects, the paper shares evidence that CHWs have served in critical roles to improve equitable access to COVID-19 testing, vaccination, and therapeutics. These examples illustrate how CHW models can bridge systemic and cultural gaps in coverage, service delivery, and affordability, demonstrating potential to make meaningful progress in improving health outcomes and reducing health disparities.

The COVID-19 pandemic has underscored the importance of CHWs within community-based care delivery models. Also known as “promotoras or promotores de salud”, “lay health advisers” or “health navigators,” CHWs are essential links in community-based care delivery models and assume critical roles both within and outside of clinical settings.

Growing interest among health systems, payers, government agencies, and community-based organizations to advance health equity, including the Centers for Medicare & Medicaid Services’ (CMS) Framework for Health Equity, has created a window of opportunity to translate evidence from the COVID-19 pandemic to broader health care transformation efforts that focus on health equity.

The policy recommendations:

• Define who community health workers are and the kinds of roles they assume. It maps identified RADx-UP CHW roles to 10 core roles described by The National Community Health Worker Core Consensus (C3) Project.
• Apply the RADx-UP Health Equity Policy Framework, previously developed and published by RADx-UP CDCC’s Community Engagement Core in 2022, to assess policy implications related to projects’ CHW interventions.
• Outline actionable short-term and long-term steps for policymakers, payers, funders, and researchers to facilitate sustainability of CHW models. Policy recommendations 1-3 highlight specific near-term steps to prioritize CHWs into existing health care transformation reforms, including through performance measures, alternative payment models, and certifications. Policy recommendations 4-5 focus on long-term steps to promote the use of community-engaged interventions through expanded research capacity for evaluation and increased multi-year funding mechanisms.

Read the policy paper and access additional resources.