Peer support as “being there” with proper training can save lives

Some of our recent blogs have focused on state and national level policies regarding peer supporters and community health workers (CHWs). Although understanding these policies is a critical factor in successfully implementing peer support programs, it is difficult to illustrate the individual level benefits such programs can have when discussing state or federal guidelines. A recent article on the UNICEF website  by Madeleine Logan does an excellent job highlighting the impact two CHWs have had on their community.

In 2008 the UNICEF-funded Community Case Management program in coordination with the Ghana Health Service visited the community of Kpalsako and offered to train two local volunteers to treat children sick with malaria and diarrhea. The community selected two members to receive training to be Community Based Agents (CBA). The members selected were then trained to treat children between 6 months and 5 years old and educate the community about positive health and hygiene practices. In 2010 the CBA’s received training in treating pneumonia as part of ongoing support for the program. CBA’s were also given medication to treat the community children including malaria medication, amoxicillin syrup for pneumonia, and zinc tablets and oral rehydration salts to treat diarrhea. Finally, the CBAs were trained to refer sick children to the nearest community health center if their symptoms do not improve, but offer a critical tie to health care for the community because the center is an hour walk away on foot.

In addition to the strong personal narratives contained in the article , the impact of this program was reflected in the number of malaria cases in the community with an estimated drop from 15 to 5 cases per month in children since the CBAs were trained. The program has been successful in communities outside of Kpalsako as Ghana Health Service National Child Health Coordinator Isabella Sagoe-Moses notes CBAs have brought health care to those most in need. It is estimated that the programs community volunteers treated approximately 83,000 cases of malaria and 17,000 cases of diarrhea in the three northern regions of Ghana in 2010.

While this blog will continue to focus on research projects, funding opportunities, key findings in peer support and many other topics we continue to recognize the importance of highlighting the success of peer support programs around the globe of all sizes. Success stories are regularly highlighted on our Facebook Page and we invite our readers to share their own stories and findings for future blog posts.

Peer Supporters Play Prominent Role in Recent CMS Innovation Funding

In November 2011 the Centers for Medicare and Medicaid Services (CMS) announced the Health Care Innovation Challenge program that would award up to $1 billion in grants for efforts to improve care and lower costs for patients with public coverage. On May 1st, The Office of Health and Human Services announced the first 26 recipients of these grants totaling $122.6 million. Many of these projects are of particular interest to those working with community health workers and in the field of peer support. This blog takes a brief look at some of the innovative ways recipients have proposed incorporating peer support in their grants:

The Center for Health Care Services in San Antonio Texas was awarded $4,557,969 for work with homeless adults in San Antonio with severe mental illness or co-occurring mental illness and substance abuse disorders, at risk for chronic physical diseases. Their intervention will integrate health care into behavioral health clinics. A multi-disciplinary care team will coordinate behavioral, primary, and tertiary health care for patients that are primarily Medicaid beneficiaries or eligible for Medicaid to improve their capacity to self-manage, reducing emergency room admissions, hospital admissions, and lowering costs, while improving health and quality of life and with estimated savings of $5 million over 3 years. The program will train workers to provide peer support to generate readiness for change, build motivation, and sustain compliance.

The Courage center in Minnesota received $1,767,667 to test a community-based medical home model to serve adults with disabilities and other complex health conditions. The intervention will coordinate and improve access to primary and specialty care, increase adherence to care, and empower participants to better manage their own health. Over 50 Independent Living Skills Specialists, Peer Leaders, and other health professionals will be trained with enhanced skills to fulfill the medical home mission. This community-based and patient-centered approach is expected to reduce avoidable hospitalizations, lower cost, and improve the quality of care for this vulnerable group of people with an estimated savings of over $2 million over the three year award.

Duke University, in conjunction with the University of Michigan National Center for Geospatial Medicine, Durham County Health Department , Cabarrus Health Alliance (Cabarrus County, NC), Mississippi Public Health Institute, Marshall University, and Mingo County Diabetes Coalition (Mingo County, WV) received $9,773,499 for its plan to reduce death and disability from Type 2 diabetes mellitus among fifty-seven thousand people in four Southeastern counties who are underserved and at-risk populations in the Southeast. The program will use informatics systems that stratify patients and neighborhoods by risk, target communities in need of higher-intensity interventions, and serve as the basis for decision support and real-time monitoring of interventions. Local home care teams will provide patient-centered coordinated care to improve outcomes and lower cost — expecting to reduce hospital and emergency room admissions and reduce through preventive care the need for amputations, dialysis, and cardiac procedures with estimated savings of over $20 million. Over the three-year period, this collaborative program will train an estimated 88 health care workers and create an estimated 31 new jobs. These workers include new types of health workers including information officers, health integrators, and community health workers, who will use novel technologies to facilitate communication, education, and care delivery.

Joslin Diabetes Center, Inc. received $4,967,276 to expand their “On the Road” program that will send trained community health workers into community settings to help approximately 3000 Medicare and Medicaid beneficiaries and low income/uninsured populations understand their risks and improve health habits for the prevention and management of diabetes. The program will target at risk and underserved populations in New Mexico, Pennsylvania, and Washington, D.C., helping to prevent the development and progression of diabetes and reducing overall costs, avoidable hospitalizations, and the development of chronic co-morbidities.

After our previous blog discussing community health workers in the US workforce and efforts to demonstrate their value to the healthcare system, this round of funding demonstrates the government’s interest in increasing the role of community health workers and peers supporters in the health system. To read about the other award winners please check out http://innovations.cms.gov/initiatives/Innovation-Awards/Project-Profiles.html. The next round of recipients will be announced in June and we will look forward to seeing additional ways for peer supporters and community health workers to be incorporated into improving health across the nation.

Peer Support and Community Health Workers (CHWs) Series:

“ Can CHWs integrated with primary care save cost?”


Community health workers (CHWs) – known by a variety of names such as promotoras and peer supporters – are trusted sources of support that promote health and help people manage diseases. This is the 3rd post of a 3 part blog that takes a closer look at the 3 action steps that can help promote full participation of community health workers (CHWs) in patient-centered primary care and the promotion of Community Wellness provided in a recent article by Balcazar et al.

As discussed previously, there has been an increased recognition of CHWs in the last decade including by the National Institute of Medicine, US department of labor and the Affordable Care Act. This has led to more formal training programs for CHWs as discussed in part 2. However, when investing in training as well as applications for general funding there is a consistent need to demonstrate value. Although the value that CHWs provide in improving access to care and improved health outcomes can not be overstated, there is also a need to demonstrate the cost savings CHWs may have on the healthcare system. With that in mind, this 3rd blog takes a look at selected programs where the return on investment (ROI) and cost saving of CHWs has been demonstrated.

The Arkansas Community Connector program integrated CHWs into long-term care by finding community members in three disadvantaged Arkansas counties and connecting them to Medicaid home and community-based services. In a three year study involving nearly 2000 participants, those connected with CHWs reported a 23.8 percent average reduction in annual Medicaid spending per participant (Felix et al, 2012)

In Colorado, the Denver Health program is the primary healthcare “safety net” for underserved populations in Denver. They employ CHWs that provide a variety of services including community-based screening and health education, assistance with enrollment in publicly funded health plans, referrals, system navigation, and care management (Whitley et al., 2006). Over a 9 month period patients working with CHWs had an increased number of primary care visits and a decrease in urgent and inpatient care. This resulted in a $2.38 ROI for every dollar invested with the CHWs (Whitley et al, 2006). 

In Kentucky, the Kentucky General Assembly authorized the Kentucky Homeplace Program in 1994. This program currently employs 39 CHWs, called family health care advisors, who provided services to 13,000 clients in 2007 across 58 predominately rural counties. The program received 2 million dollars in funding and in 2007 and was estimated to provide $15 to $20 of free or discounted medical services for every dollar invested (Goodwin & Tobler, 2008).

In Maryland, Baltimore CHWs working with diabetes patients on Medicaid achieved a 38% reduction in emergency room visits leading to a 27% drop in Medicaid costs for the patients. It was estimated that each community health worker was responsible for $80,000 to $90,000 dollars in savings by alternating weekly home visits and phone contacts (Fedder et al. 2003).

Although these 4 programs vary greatly in size and scope, they are all important in adding to a growing evidence base suggesting CHWs have the potential to provide substantial cost savings in the health care system. Further documentation of the financial impact of these programs can only serve to strengthen the argument for funding such programs. As CHWs continue to receive more recognition and the opportunity for more standardized training, demonstrating their financial impact will take on increased significance.

Balcazar, H., Rosenthal, E. L., Brownstein, J. N., Rush, C. H., Matos, S., & Hernandez, L. (2011)

 Fedder, D. O., Chang, R. J., Curry, S., & Nichols, G. (2003). The effectiveness of a community health worker outreach program on healthcare utilization of west baltimore city medicaid patients with diabetes, with or without hypertension. Ethnicity & Disease, 13(1), 22-27.


Felix, H. C., Mays, G. P., Stewart, M. K., Cottoms, N., & Olson, M. (2012). The care span: Medicaid savings resulted when community health workers matched those with needs to home and community care. Health Affairs (Project Hope), 30(7), 1366-1374. doi:10.1377/hlthaff.2011.0150

Goodwin K., Tobler L. (2008). Community health workers. Issue Brief of the National Conference of State Legislators, 1–11

Whitley, E. M., Everhart, R. M., & Wright, R. A. (2006). Measuring return on investment of outreach by community health workers. Journal of Health Care for the Poor and Underserved, 17(1 Suppl), 6-15. doi:10.1353/hpu.2006.0015