Value and Access | Joint Policy Statements

The Vital Role of Community Health Workers

Community health workers (CHWs) are uniquely positioned to address health disparities by bridging the gap between clinical care and community needs. CHWs deliver tangible health benefits, such as:

• Reducing emergency room visits.
• Improving chronic disease management.
• Increasing access to preventive care.

Economic and Social Impact

Research shows that investing in CHWs not only improves health outcomes but also delivers significant economic benefits. For every $1 invested in CHW programs, the return on investment can reach up to $2.47.

“Community health workers are the connective tissue in healthcare, bridging the gap between clinical care and community needs,” said John M. Clymer, executive director of the National Forum. “Investing in their success yields healthier communities.”

Recommendations for Action

To empower CHWs to continue bridging gaps in care, the policy statement calls on policymakers, healthcare organizations, and community leaders to:

1. Expand Medicaid Support Incentivize Medicaid programs to reimburse CHW services and support stable, full-time roles.
2. Increase Access Utilize Medicare’s community health integration codes to reimburse for essential services addressing social determinants of health.
3. Build Capacity and Enhance Impact Invest in CHW training through federal funds, such as the American Rescue Plan Act.
4. Integrate CHWs into Team-Based Care Encourage employers to embed CHWs into multidisciplinary healthcare teams.
5. Add CHWs in Policy and Practice Include and explicitly name CHWs as essential care team members in legislation, regulations, funding announcements, and healthcare models.

A Call to Action

The joint policy statement reflects the collective commitment of groups representing patients, physicians, pharmacists, nurses, public health practitioners, and CHWs nationwide. By implementing these recommendations, communities can ensure fair access to care and improved health outcomes for all.

The Case for Pharmacist-Provided Care

Chronic conditions like diabetes, high blood pressure, and heart disease are among the leading drivers of healthcare costs, hospitalizations, and preventable deaths in the United States. Evidence consistently shows that integrating pharmacists into patient-centered, team-based care models significantly improves health outcomes while reducing costs.

“Patient-centered, team-based care, which includes pharmacists, improves patient outcomes and is cost-effective,” says Dr. Warren A. Jones, past president of the American Academy of Family Physicians and professor emeritus at the University of Mississippi Medical Center.

With more than 90% of Americans living within five miles of a pharmacy, pharmacists are uniquely positioned to serve as accessible, trusted healthcare providers. However, in many states, regulatory barriers and unsustainable payment models limit the services pharmacists can offer, restricting access to essential care for patients who need it most.

Policy Recommendations to Drive Change

To sustain and expand these advancements, the coalition is urging policymakers to:

1. Ensure Medicare Reimbursement: Establish permanent Medicare Part B coverage for pharmacist-provided services to create sustainable care delivery models.
2. Clarify Reimbursement Authority: Enable Medicare and Medicaid to reimburse pharmacists for clinical services such as screenings, immunizations, and chronic disease management, with proper coding and billing systems.
3. Enhance Billing Opportunities: Allow pharmacists to bill at higher levels for evaluation and management services under Medicare, improving access to advanced care.
4. Adopt Pandemic-Era Flexibilities: Make permanent the temporary pharmacy authorities established during the pandemic to expand access to clinical care and essential medications.
5. Expand Telehealth Services: Empower pharmacists to provide telehealth and telepharmacy care, especially in rural and underserved communities.

A Call to Action

As the nation braces for future public health challenges, empowering pharmacists to practice at the top of their licenses is more critical than ever. By implementing these policy changes, healthcare systems can address disparities, reduce preventable deaths, and support sustainable care delivery for all Americans.