At a time when pressures from workforce shortages in the health care industry have reached an unprecedented level, I am pleased the New Hampshire legislature is considering timely legislation that will bolster our state’s current workforce and strengthen our workforce pipeline in the long-term: SB 403. I am writing today to demonstrate the much-needed support this bill would provide for an essential component of our health care workforce: Community Health Workers (CHWs).
My organization, Southern New Hampshire Area Health Education Center (AHEC), is one of three offices of our statewide network of AHEC programs that provide training opportunities and continuing education for health care workers, including CHWs. These individuals are an incredible support system for patients and are employed at New Hampshire hospitals, federally qualified health centers, health departments, family resource centers, public health networks and other community-based organizations. (A 2023 survey administered by my organization showed that 42% of New Hampshire CHWs work in clinical settings, and 58% work in community-based organizations, local health departments, schools, insurance providers, and family resource centers).
When we think about what contributes to positive health outcomes, we know that medical care is responsible for 20%, while 80% is determined by “social determinants of health,” the conditions in the environment where we live, learn, and work that affect a wide range of our health- and quality-of-life outcomes. This is where CHWs come in: They are a huge component of delivering primary and preventive care, helping patients in a range of ways, whether it be accompanying patients to the hospital or a clinic; visiting patients at home; educating them about prevention of health issues; or helping them to access life-saving medications and take their medications correctly and on time (for example, after a patient is discharged from the hospital).
As a result of the increased need in health care and public health, coupled with increased evidence of their cost-effectiveness and effectiveness in improving health, the CHW workforce is evolving rapidly in terms of professional identification and institutional recognition: There is a growing body of research showing that CHWs reduce the number of hospital days, improve blood sugar control among people with diabetes, and help people get the care they need before they get sicker. They are often a lifeline for individuals who are experiencing homelessness, people with substance use disorders, and people with disabilities.
Right now, in New Hampshire CHW services are not reimbursed. This means that health care organizations who employ them must find and secure funding through short-term grants. SB 403 would overcome this barrier by creating voluntary certification of CHWs, thereby setting the standards to allow CHWs to be eligible for reimbursement. In layman’s terms, this means the hundreds of dedicated CHWs in New Hampshire won’t have to fear losing their jobs because a funding stream dries up.
We at the AHEC have identified that a barrier frequently mentioned by CHWs is instability around funding, both in terms of having enough funding to offer higher salaries and having sustainable funding so that positions are not dependent on grants and other one-time funding sources. SB 403 is a key policy solution to this recruitment/retention barrier. It is important to note that non-certified CHWs may be very skilled and keeping up in the field, which is why this certification in New Hampshire would be voluntary. And this bill would have no financial impact on the State.
In my 26 years as the Director of the Southern NH Area Health Education Center, I have never seen the need so great to invest in our health care workforce. They need and deserve our support. In my field, I see firsthand that New Hampshire health care organizations are experiencing an incredible amount of competition with other industries such as manufacturing and retail. SB 403 will have a positive impact for the wide swath of health care organizations who employ CHWs, and most importantly, for their patients.
With the House of Representatives expected to vote on the bill this Thursday, May 2nd, I am grateful for this opportunity to encourage a growing appreciation for the healthy, life-saving work that CHWs are doing out in Granite State communities every day.
Paula Smith, MBA, EdD
Director, Southern NH AHEC
Contract Administrator, Seacoast Public Health Network
Comments