Tennessee Recognizes the Vital Role of Community Health Workers
November 21, 2024 · Becky Kolinski
Community health workers (CHW) play a vital role in health care and social services systems by connecting people with the services and support they need. Because of their lived experience in the community, CHWs understand the challenges and barriers people face when obtaining health care, and can build trusted relationships.
Many organizations employ CHWs to screen for social determinants of health and help people access resources for transportation, financial assistance, food and shelter. CHWs are knowledgeable and resourceful—but they need the right balance of flexibility, autonomy and support to do their jobs effectively.
To promote the value of community health workers and create a structure to help them succeed, the Tennessee Community Health Worker Association (TNCHWA) launched an accreditation program for organizations that employ community health workers. The program is sponsored by TennCare—the state Medicaid program in Tennessee—and was developed with technical assistance from NCQA.
“We are honored that TennCare asked us to be their partner in developing this program,” says Nikayla Boyd, Executive Director of TNCHWA. “They wanted to make sure the voice of community health workers was heard throughout the process, and we were able to accomplish that.”
Building a Framework for Accountability
While many states have individual certifications for CHWs, there are no nationally recognized standards for the organizations that employ them. The new accreditation program outlines best practices for designing and implementing programs that will lead to high-quality outcomes for CHWs and the people they serve.
To develop the standards, TNCHWA built on existing research and the experience and insights of a broad range of stakeholders, including CHWs, their supervisors, academic contributors, state and county health departments, agencies that employ CHWs and health care practitioners.
The result is a set of seven standards that provide the structure for CHW programs.
- Recruitment and hiring. Includes job descriptions, hiring and interview processes and diversity, equity and inclusion.
- Scope of Work for CHWs. Defines roles and responsibilities, caseloads and use of evidence-based best practices.
- Support for CHWs. Includes job supports, documentation tools, emergency protocols and emotional well-being.
- Training. Involves initial and ongoing training, peer support and opportunities for flexible training assessments for CHWs who are not confident in their writing skills.
- Performance Evaluations. Describes the timing and content of evaluations.
- Professional and Workforce Development. Covers processes for professional development, appropriate compensation, integration of CHWs into the organization and empowerment of CHWs.
- Supervision. Defines the qualifications, oversight and training for CHW supervisors.
“Community health workers have been doing this work for decades,” says Boyd. “This accreditation elevates existing programs by providing a structure that helps them document their processes. Our goal in working with NCQA was to create a process that is fair and achievable for organizations of all sizes.”
How NCQA Supports TNCHWA
TNCHWA contracted with NCQA to develop the accreditation process, including:
- Designing the scoring methodology and evidence requirements—what organizations need to show to demonstrate compliance with a standard.
- Creating the program’s infrastructure, including manuals, reviewer guidance and scorecards.
- Providing training and technical assistance for onsite reviewers.
- Compiling results and delivering a final score for each organization.
“Community health work is defined by local needs, so it is important to engage with people who understand the dynamics of the region,” says Jennifer Lenz, Vice President, State and Foundation Services at NCQA. “Working with TennCare and TNCHWA, we were able to create a customized accreditation program that reflects the needs and priorities of Tennessee.”
Securing the Future for CHW Services
CHWs provide help for people, where and how they need it—and often in ways that traditional care delivery systems cannot accommodate. While CHW services have experienced long-standing support from community-based organizations, philanthropic organizations and public health agencies, Medicaid reimbursement models vary by state. The recent decision to reimburse these services under the Medicare program could encourage more states to follow suit.
While accreditation is not required for reimbursement, it does set standards that define a quality program, which can help payers—including state Medicaid programs and commercial health plans—feel confident in their decision to reimburse these services. It can also build a stronger, more empowered workforce by giving CHWs the support they need to do their job successfully.
“Many community health worker programs operate on tight budgets, where lost funding means a lost program,” says Boyd. “We hope this accreditation will further legitimize and, hopefully, sustain these programs by making them more attractive to potential funders.”
What’s Next?
TennCare has provided grant funding for up to 14 organizations to complete the accreditation process by 2026. TNCHWA completed a pilot of the survey process with 2 organizations to gather feedback, and NCQA is working with TNCHWA to implement improvements for the remaining surveys.
“We’ve genuinely enjoyed the collaboration with NCQA on this project. They view us as an equal partner and respect our expertise,” says Boyd. “And we are so grateful to TennCare for providing the funding and strategic vision to make this happen.”
For more information, visit the TNCHWA website.
