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Community health workers (CHWs) have shown, time and again, that they can improve health outcomes while reducing healthcare costs. Reductions in chronic illness, improved medication adherence, more patient involvement, and better community health have been accompanied by a return on investment of more than $2 for every dollar invested.

One approach states have explored to counteract these barriers is to develop some sort of CHW credentialing system. The goals of credentialing, as described by Carl Rush in 2012, are to achieve greater respect for CHWs among other healthcare professions, improved financial compensation and working conditions, increased job stability, and opportunities for more sustainable funding. The connection between insurance reimbursement and credentialing or standardized training is particularly significant, as both public and private insurance plans are likely to require some form of credentialing in order to pay for CHW services. At the same time, many CHWs are concerned that credentialing will create barriers to entry for the individuals best suited to the job (i.e., members of low-income communities who may not speak English as a first language), and/or take CHWs away from their community connections by focusing on credentialed ―skills‖ over community relationships.

This report by Harvard Law School's Center for Health Law & Policy Innovation is designed to review some of the major policies in different states and highlight some of the issues that arise in these programs. There is no single right approach. With sufficient stakeholder engagement, each state can develop policies tailored for its community.

"Trends in Racial Disparities for Asthma Outcomes among Children 0 to 17 Years, 2001-2010."

Authors: Akinbami, Lara J., MD, Jeanne E. Moorman, MS, Alan E. Simon, MD, and Kenneth C. Schoendorf, MD

Journal of Allergy and Clinical Immunology, Volume 134.3 (2014), 547-553

View the full article here: http://www.jacionline.org/article/S0091-6749(14)00798-2/fulltext

Abstract:
Background –
Racial disparities in childhood asthma have been a long-standing target for intervention, especially disparities in hospitalization and mortality.

Objectives –
Describe trends in racial disparities in asthma outcomes using both traditional population-based rates and at-risk rates (based on the estimated number of children with asthma) to account for prevalence differences between race groups.

Methods –
Estimates of asthma prevalence and outcomes (emergency department [ED] visits, hospitalizations, and deaths) were calculated from national data for 2001 to 2010 for black and white children. Trends were calculated using weighted loglinear regression, and changes in racial disparities over time were assessed using Joinpoint.

Results –
Disparities in asthma prevalence between black and white children increased from 2001 to 2010; at the end of this period, black children were twice as likely as white children to have asthma. Population-based rates showed that disparities in asthma outcomes remained stable (ED visits and hospitalizations) or increased (asthma attack prevalence, deaths). In contrast, analysis with at-risk rates, which account for differences in asthma prevalence, showed that disparities in asthma outcomes remained stable (deaths), decreased (ED visits, hospitalizations), or did not exist (asthma attack prevalence).

Conclusions –
Using at-risk rates to assess racial disparities in asthma outcomes accounts for prevalence differences between black and white children, and adds another perspective to the population-based examination of asthma disparities. An at-risk rate analysis shows that among children with asthma, there is no disparity for asthma attack prevalence and that progress has been made in decreasing disparities in asthma ED visit and hospitalization rates.

This tool kit is intended for organizations who want to start a new asthma home visit program or add to an existing program. It includes descriptions of each visit, pilot program data, lessons learned, successes, and more. The forms provided in the appendix of tools are for public use and can be edited to fit different organization’s needs. The guidance provided in this tool kit is not intended to replace comprehensive training prior to providing home visiting services to the public.