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The Patient Protection and Affordable Care Act (PPACA) affords opportunities to sustain the role of community health workers (CHWs).
Among myriad strategies encouraged by PPACA are prevention and care coordination, particularly for chronic diseases, chief drivers of increased health care costs. Prevention and care coordination are functions that have been performed byCHWsfor decades, particularly among underserved populations.
The two key delivery models promoted in the PPACA are accountable care organizations and health homes. Both stress the importance of interdisciplinary, interprofessional health care teams, the ideal context for integratingCHWs.Equallyimportant, the payment structures encouraged by PPACA to support these delivery models offer the vehicles to sustain the role of these valued workers. (Am J Public Health. 2011;101:e1-e5.doi: 10.2105/AJPH.2011.300335)
THE PATIENT PROTECTION AND Affordable Care Act (PPACA), with its interconnected emphasis on improving quality and reducing cost, provides unprecedented opportunities for CHWs to serve more formally as integral participants in fixing a fragmented health care system that threatens not only this country's solvency but also the well-being of its citizens.
CHWs, defined by the US Department of Labor as workers who ''assist individuals and communities to adopt healthy behaviors'' while helping ''to conduct outreach'' and ''advocate for individuals and community health needs,''1 remain to a large extent an underused workforce.
The PPACA recognizes the role of CHWs in achieving the goal of improving health outcomes and containing costs. In Section 5313 of the PPACA, Subtitle B-Innovations in the Health Care Workforce, CHWs are explicitly cited as an important part of the care team for delivery system reform.2 Similarly, in Subtitle D-Enhancing Health Care Workforce Education and Training, the law authorizes funding through the Centers for Disease Control and Prevention for CHWs to help promote positive health behaviors and outcomes in medically underserved communities.3 The PPACA, using the definition for CHWs set by the Department of Labor,1 outlines several activities for CHWs, including education, guidance, and outreach to ameliorate health problems prevalent in underserved communities; education and outreach regarding health insurance; and education about, referral to, and enrollment of people in appropriate health care and community programs to improve the quality of these services and eliminate duplicative care.
According to the PPACA, priorities for these services should be given to communities with a high percentage of uninsured but...