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A well-established pillar of Colorado’s healthcare system received powerful additional support in late April with bipartisan passage of Colorado SB23-002. The bill will allow Medicaid reimbursement for some services provided by community health workers (CHWs), who help to connect patients to vital healthcare and community services, provide education, and decrease barriers to care, among other tasks. CHWs often go by a variety titles, including health navigators and lay health workers.

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) that delineates the specific CHW services to be covered by Medicaid and the rate of reimbursement for them. Later this year, HCPF will hold public hearings to receive input from CHWs, public health agencies, and other “stakeholders” about the CHW services to be covered, their qualifications, their roles and other points necessary for the CMS submission.

Representatives from the Colorado School of Public Health provided lawmakers with important data to aid them in considering the bill, which Governor Jared Polis signed into law on May 10. Their input centered on the long and successful track record of CHWs in helping improve access to care for underserved patients, contributing to cost-effective care and improving patient outcomes.

The information helped the bill gain bipartisan support from legislators representing not only urban communities of color and cities along the Front Range with large numbers of the working poor, but also small rural and frontier towns, said Andrea (Andi) Dwyer, director of the Colorado Cancer Screening Program and senior professional research assistant in ColoradoSPH’s Department of Community & Behavioral Health.

“We were able to show the investments in the program and the returns,” Dwyer said. “That set us up in good position to help leverage and educate people about the impact of the bill.”

What’s 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 in ColoradoSPH’s Center for Public Health Practice, clinical assistant professor of community and behavioral health, and interim director of ColoradoSPH’s Latino Research and Policy Center. “They support patients who have potential challenges that make it difficult to access and complete treatments and self-manage their care,” she added. The assistance includes connecting patients to transportation, financial assistance, support groups, behavioral health and medical interpretation. Valverde directs the long-running Patient Navigation and Community Health Worker Training (PNCT), a key pipeline for CHWs. She said the collaborative has trained more than 2,000 patient navigators since its inception. That information was vital for drafters of the bill who wanted to avoid creating new systems and processes for the CMS reimbursement plan.

“We showed that we have an existing process and infrastructure available for navigators and other CHWs to be trained, and our state has a system in place to assess their competencies,” Valverde said.

In addition, Valverde teamed with DrPH student Shenazar (Shane) Esmundo to compile the growing body of peer-reviewed literature that has evaluated the effectiveness of CHWs. That information helped to educate legislators, not only about the importance of CHWs, but also that there was no longer a need to call for more data to support their role in the healthcare system.

Demonstrating the effectiveness of CHWs

“Patient navigators and other community health workers are sometimes the only intervenors that are truly shown to make impacts as it relates to reducing barriers for access to care and improving equitable approaches,” Dwyer said.

Testifying in support of the bill, Dwyer pointed out statistics that support the success of patient navigators in guiding some 36,000 patients across the state to screenings for colorectal cancer:

· 92% of patients show up for exams

· 98% complete exams

· More than 250 cancers have been detected

· An estimated 750+ cancers have been prevented through detection of advanced adenomas

· Savings to the healthcare system were an estimated $15 million

Navigators also help improve care by freeing up nurses, physicians and other medical providers “in the most effective way possible,” Dwyer added.

“If [patient navigation] were a pill or [medical] device, it would have been covered years ago,” she stated.

A measure of financial stability, but more work ahead

Dwyer and Valverde each noted that SB23-002 is especially important as state and grant funding for CHWs has shrunk in recent years.

“The bill finally provides at least one channel for financial stability for the positions,” Valverde said. “If we had not done anything, at some point we would really be struggling to keep [them] in place.”

Dwyer emphasized that the passage of the bill is “only one hurdle” in a broader effort to make CHWs a healthcare system fixture. The next challenge is to expand reimbursement for CHWs to private payers and Medicare, she said. However, that will require keeping the concept of patient navigation at the forefront of healthcare discussions, an effort she has worked on addressing with the Patient Navigation Sustainability Assessment Tool, developed by ColoradoSPH and the American Cancer Society’s National Colorectal Cancer Roundtable.

“If we don’t find a way to show our value and impact, have champions, engage communities and continue to nurture policy, these things don’t stay,” Dwyer said.

Written by Tyler Smith for the Colorado School of Public Health.