New Data: Leveraging the Power of California’s Community Health Workers, Promotoras, and Community Health Representatives

In the vast tapestry of California’s healthcare system, an unsung set of workers often bear the weight of essential healthcare transformation: Community Health Workers, Promotoras, and Community Health Representatives (CHW/P/R). This workforce of change agents is often the lifeline connecting historically marginalized communities to essential care and resources—and moving the needle on improved health outcomes and equity—yet remains one of the most underestimated and under-resourced assets in the healthcare system. 

A major hurdle to supporting CHW/P/Rs and leveraging their power is a lack of comprehensive data about this workforce, which complicates the challenging tasks of allocating resources, advocating for the workforce, and catalyzing broader care transformation. 

Now, a new data set shines a light on California CHW/P/Rs and their work, affording us actionable insights on a set of workers who have played a pivotal role largely out of view.

Health Net, one of the largest Medi-Cal managed care plans in California, partnered with HealthBegins in 2023 to design and launch a statewide CHW/P/R Employer Survey. The survey findings reveal the full scope and scale of CHW/P/R work across the state and illuminate the magnitude of these workers’ untapped potential. This new data can help plans and providers across California and beyond understand the value of this workforce and prepare to expand its impact.

CHW/P/R Workforce Resource Hub

Invisible Community Heroes

At HealthBegins, we hold Community Health Workers, Promotoras, and Community Health Representatives in the highest regard. They are often unsung heroes who work on the frontlines, addressing social needs and health inequities, and ensuring that their communities have access to quality health care, regardless of their socioeconomic backgrounds. Their work extends far beyond care coordination, encompassing translation services, informal counseling, providing culturally appropriate health education and information, and creating bridges to a healthcare system that many often find intimidating and inaccessible.  As one California community-based organization leader said while participating in this project, “I want to highlight how deeply connected CHW/P/Rs are to their communities and the lengths that they will go to support their communities to get the resources that they need.” 

However, despite their contributions, CHW/P/Rs are often undercut by limited resources and inequitable compensation. As a result, CHW/P/Rs often find themselves in a precarious position, caught between their commitment to their communities and the need to make ends meet. Programs employing CHW/P/Rs frequently face a similar bind.

Filling the Data Gap

California’s healthcare landscape is complex and multifaceted, with various programs and initiatives vying for funding and support. Despite their commitment to health equity, programs that leverage the power of the CHW/P/R workforce, often fall by the wayside due to lack of data. Proper data collection and analysis are essential for recognizing the scale of the CHW/P/R workforce and its impact. Without accurate, comprehensive data, it is challenging to advocate for the resources and recognition the CHW/P/R workforce needs and deserves.

Recognizing this, Health Net partnered with HealthBegins on the 2023 CHW/P/R Employer Survey to (1) prepare for the new CHW Medi-Cal Services Benefit, as well as other new state Department of Health Care Services care transformation initiatives; (2) better understand California-based CHW/P/R employers and existing services that are reimbursable; and (3) accelerate collaboration among plans, providers, and community-based organizations to operationalize the new CHW Medi-Cal Services Benefit.

The findings reveal that CHW/P/Rs can play a pivotal role in addressing a wide range of health inequities, far beyond their current scope of work. The findings highlight that with proper recognition, training, and resource allocation, the CHW/P/R workforce can significantly contribute to improving health outcomes in areas such as mental health, substance misuse, maternal and child health, and chronic disease management. By expanding their roles and integrating them more comprehensively into healthcare teams, California can leverage the full potential of CHW/P/Rs to drive transformative impact in these critical areas. As one FQHC leader said, “As a CalAIM provider, we’ll need to look at how to integrate CHWs into our system of care. We’re looking at how we are reaching and connecting with domestic violence prevention to connect them to medical and mental health services.”

The Path Forward

Health Net and HealthBegins’ data collection effort is a starting point to inform additional pathways for more effective and timely interventions to support organizations that train and employ the CHW/P/R workforce, especially those that are interested in pursuing and utilizing the CHW Medi-Cal Services Benefit in California. That’s why we’re grateful to the many organizations and coalitions leading pathbreaking work in this space, including several like the California Pan-Ethnic Health Network, California Primary Care Association, and California Association of Community Health Workers, that supported the CHW/P/R employer survey as channel partners. 

Together, advocates, policymakers, and health plans have the power to transform healthcare in California by leveraging the lived experience and community expertise of CHW/P/Rs to address community-level social determinants of health and advance health equity. To advocate for and advance CHW/P/R workforce sustainability, advocates, policymakers, and health plans can:

  • Advocate for recognition and investment: Improvement starts by acknowledging the vital role CHW/P/Rs play in advancing health equity and recognizing them as integral members of the healthcare team. We must encourage policymakers to fund proper training, education, and fair compensation. CHW/P/Rs deserve the resources they need to thrive and expand their reach. 
  • Expand scope of practice: Policymakers can revisit regulations and expand the scope of services for the CHW/P/R workforce, allowing them to address a broader range of health and social inequities from mental health to chronic disease management, and deeming these billable services. Policymakers can work with community organizations to champion policy changes at the state, local, and federal levels. 
  • Engage communities: Health plans can directly engage with the communities they serve to identify their unique needs and preferences. This grassroots approach ensures that CHW/P/R programs and services are culturally sensitive and community-driven.
  • Promote research and data collection: All parties can support research initiatives to gather robust data on CHW/P/R interventions and quantify their impact on health outcomes and cost savings. Armed with compelling data, advocates can make stronger cases for the value of CHW/P/R workforce sustainability.

As the new data and our own experience make clear, California’s CHW/P/R workforce represents an invaluable resource that, when fully leveraged, has the capacity to revolutionize the state’s healthcare system, reduce health inequities, and promote equitable access to care for all.

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Alejandra Cabrera is the Senior Program Manager at HealthBegins