Partnering with Community Health Workers to Better Manage and Prevent Asthma

RAMP is committed to increasing access to culturally-competent quality clinical care, and has long been committed to building the field of Community Health Workers (CHWs), who are often very successful in improving health outcomes and reducing healthcare utilization, especially in systemically excluded communities. Because CHWs are often members of the communities they serve, RAMP is also building the capacity and workforce in communities on the ground.

Why CHWs and Promotoras?

Community Health Workers (CHWs) and promotoras serve an essential role in asthma management. Robust evidence shows that CHWs and promotoras provide effective asthma self-management and environmental education, bridge the gap between patients and their providers, offer social services such as interpretation and referrals, and perform care coordination.

CHWs/promotoras are recognized as uniquely effective in delivering culturally competent home-based asthma interventions because they often have shared cultural backgrounds with participants. Even in cases where there is not a shared cultural background, effective asthma educators practice cultural humility, which is the process of bringing into check the power imbalances between the provider and the individual or family. The CHW/promotora approach to a culturally humble process involves asking questions to gain knowledge, achieving mutual respect, and moving toward shared goal-setting and decision-making.

Innovations in state approaches to Medicaid, as well as the leadership of some private payers, are creating more opportunities for CHWs, promotoras and other non-licensed providers to be reimbursed for providing services in home and community settings.

Advocacy to integrate CHWs and promotoras into the health care system

RAMP engages in a wide range of policy efforts aimed at addressing the burden of asthma, including advocating for the integration of CHWs and promotoras into the health care system. In 2017, RAMP advocated strongly for a California bill authorizing Medi-Cal reimbursement for CHWs and others to provide asthma education and in-home environmental assessments—a bill that passed through every legislative vote with bi-partisan near-unanimous support.

Largely resulting from advocacy efforts of organizations and networks across the state, in 2022 the California Department of Health Care Services (DHCS) is working to draft two State Plan Amendments (SPAs) to allow Medi-Cal reimbursement to non-licensed professionals, such as CHWs and promotoras. The SPAs will be submitted to the federal Centers for Medicare and Medicaid Services for approval by mid-2022.

The first SPA would allow Medi-Cal reimbursement to CHWs and promotoras for a broad range of work in communities across California. DHCS has convened a group of stakeholders to guide this process. RAMP’s Director, Anne Kelsey Lamb, was appointed to the stakeholder group and brings the experience of two decades of working with asthma CHWs to the conversations.

The second SPA would allow Medi-Cal reimbursement to CHWs, promotoras, and other non-licensed professionals specifically for Asthma Preventive Services, which include home-based asthma education and environmental asthma trigger assessments. DHCS is working directly with RAMP and our partners to develop this SPA. RAMP’s Associate Director, Joel Ervice, is working closely with the California Asthma Financing Workgroup to guide this process. If you’re interested in learning more or being added to the Workgroup list, please contact Joel at joel@rampasthma.org.

Building the capacity of CHWs and promotoras to improve asthma management

RAMP regularly hosts convenings and learning sessions for CHWs, promotoras and others providing asthma education. Each year, the participants identify topics of interest and RAMP staff bring in expert speakers on those topics. Discussion topics include: clinical issues related to asthma care, such as guidelines updates or medication reviews; topics relevant to home visiting, such as understanding tenants’ rights or how to identify and remediate mold; and emerging topics impacting their work, like wildfire smoke or COVID-19. See a selection of recordings of past CHW meetings.

The free convenings are held via Zoom every six to eight weeks and last 90 minutes to 2 hours.  If you are interested hearing about upcoming convenings, please contact Anne Kelsey Lamb at anne@rampasthma.org.

A version of this impact story first appeared on the RAMP site.