Michael "Chris" Gibbons doesn't doubt for a moment that the kind of community health workers being trained at Temple University Hospital can make a difference in health outcomes. But paying for them is a whole 'nuther story, as I reported in my story in the Philadelphia Inquirer.
"These programs suffer because of funding," said Gibbons, a surgeon who is the associate director of the John Hopkins Urban Health Institute in Baltimore where community health workers have long been part of the program. Community health workers "can't get paid through the same mechanisms that doctors get paid -- fee for service through Medicaid or Medicare" or other insurance.
Instead, he said, his program has to rely on flavor-of-the-month funding, although he didn't use those words. Ten years ago, his program had eight community health workers, now it has two. "You have to be a revenue-generating personnel to get paid," he said. Otherwise, "you have to find funding either through philanthropy or research."
At first, the funding stream involved drug and alcohol rehabilitation. Then, the next funding came from programs designed to keep urban newborns out of neonatal intensive care units. These babies, often the children of uninsured mothers, can run up a $55,000 tab in just a few weeks. Keeping even one of them out of the neonatal unit more than makes up for the cost of the health care worker. Now, the community health workers are dealing with sickle cell anemia patients in a grant too small to fund more than two.
Under the 2010 Affordable Care Act, it looks like funding will come more on a per-patient basis, rather per-procedure. Then, the community health workers will become a boon, not a bane, he said.
"The timing is right for this type of program," he said.
• Today: Flavor of the month funding for community health workers
• Wednesday: Who gets the savings for community health workers