Siloam Health: How CHWs Can Help Improve Health Outcomes

February 19, 2025 · Becky Kolinski

To promote the value of community health workers (CHW) and create a structure to help them succeed, the Tennessee Community Health Worker Association (TNCHWA) launched an accreditation program for organizations that employ CHWs. The program is sponsored by TennCare—the state Medicaid program in Tennessee—and was developed with technical assistance from NCQA.

We’re excited to share the story of Siloam Health, one of the first organizations to be accredited through the program. Siloam Health is a faith-based, non-profit health care organization that provides primary care to underserved and uninsured populations in Nashville. It operates two clinics that serve about 6,500 patients each year.

“We focus on whole-person care that includes not just physical health care, but emotional, spiritual and social care as well,” says Amy Richardson, Chief Community Health Officer, Siloam Health. “Many of our patients are refugees and immigrants representing more than 80 different homelands and speaking more than 50 different languages—the most prevalent being Spanish and Arabic.”

Inspired by community-led models of care in other countries, Siloam Health started its CHW program in 2014. While the program has evolved, it continues to focus on one central goal: empower people in underserved communities to live healthier lives.

How Siloam’s CHW Program Works

Siloam Health employs 7 CHWs who serve 600 people annually across two programs.

• Comprehensive care focuses on people with chronic diseases such as diabetes, hypertension, anxiety and depression. CHWs work with patients on person-centered goals for 3 months; these could be related to their chronic disease or any social driver of health like stress, employment or housing.
• Rapid response is for patients who need immediate support. CHWs work with patients for 2–4 weeks to respond to urgent needs—most frequently related to food insecurity or transportation. The rapid response program began during the COVID pandemic, moved from a quarantine focus to a vaccine focus and eventually evolved into a focus on social drivers of health.

In both programs, CHWs perform an extensive intake survey to learn what’s going on in each patient’s life, identify the patient’s goals and develop a plan to meet those goals. CHWs check in with patients weekly via text, phone call or a home visit, depending on an individual’s needs.

“The most frequently requested home visit is for food assistance. Our CHWs know all the food resources in the city and can offer whichever one is the best fit,” says Richardson. “Other times, the CHW may provide a coaching home visit where they’re working on a specific goal, or offering support if a patient is struggling.”

What Siloam Looks for When Hiring CHWs

CHWs play a unique role in the care team because they share a lived experience with the people they serve. At Siloam Health, all CHWs are immigrants and are bilingual or multi-lingual—some have also lived without insurance for a period.

Another important distinction is the level of support offered to patients. CHWs don’t just hand off a resource to the patient, they walk the person through the process to ensure they have what they need.

“The main thing we look for when hiring CHWs is empathy. We can teach the hard skills, so we focus heavily on the soft skills,” says Richardson. “Situational interviews are a big part of our hiring process. We want to make sure we hire people who are highly trusted within the communities we’re trying to reach.”

The Positive Impact of CHWs

Building trust is critical when working in underserved communities. Patients often share information with CHWs that they haven’t revealed to their clinician—and that information can be highly relevant to the patient’s care.

“The trust that CHWs are able to build with our patients has improved relationships across all levels of care,” says Richardson. “We’ve started a pilot program where the CHWs perform the social needs screenings and enter that information into the chart so the care team has a more wholistic view of the patient.”

The positive impact of Siloam Health’s CHW program is clear.

• 96% of patients who start the program complete it.
• 98% of patients in the program meet one or more of their goals.
• 65% of patients in the program improve one or more health metrics.

How Accreditation Helped Siloam Health

As a founding member of TNCHWA, Richardson was a vocal supporter of the accreditation program because of the benefits for CHWs and the organizations that hire them.

“It’s important for CHWs to operate in a workplace where they are empowered and set up for success,” says Richardson. “If CHWs are left alone in an unsupportive environment, we don’t see the same outcomes—and that’s not because the CHW isn’t effective. It’s because the organizational infrastructure isn’t there to support them.”

Accreditation can enhance the reputation of the CHW workforce by setting standards that define a quality program, and by encouraging organizations to adopt best practices for hiring, training and evaluating CHW performance.

“We already had a strong CHW program, but accreditation enabled us to tighten up some policies and build even stronger integration between the CHWs and our clinical team,” says Richardson. “We’ve also been able to share our experience with some organizations that are newer to the work. It’s given us an opportunity to amplify our voice within the state.”

Learn More

• Read our blog about Tennessee’s CHW Accreditation program.
• Visit the TNCHWA website to access a copy of the standards.
• Email us at publicpolicy@ncqa.org to find out how you can advocate for a CHW accreditation program in your state.