Philadelphia-based Jefferson Health has become the first organization to receive URAC’s new Community Health Worker Program Accreditation, which seeks to establish a national standard for how health systems recruit, train, integrate, and support community health workers (CHWs). Christine James, Ph.D., L.S.W., director of the Community Health Worker Academy at Jefferson, and URAC CEO Shawn Griffin, M.D., spoke with Healthcare Innovation about what the accreditation signifies and what’s next. 

Griffin explained that URAC’s framework formalizes the role community health workers can play across care settings, as providers look for ways to improve outcomes, support patients beyond the hospital, and address social needs that affect health.
 
Jefferson’s program has grown from fewer than a dozen CHWs in 2023 to nearly 40 today, with staff embedded in both hospital and community settings. Ten to 12 new CHWs go through the academy each year. They conduct home visits, support post-discharge follow-up, coach patients with chronic conditions, and help connect patients to community-based resources. According to Jefferson, the program has already helped reduce emergency department use and readmissions, improve blood pressure control, and strengthen primary care engagement.

Healthcare Innovation: Dr. Griffin, the community health worker role is still relatively new in the healthcare ecosystem. Has there been a shift in how health systems think about workforce strategy or care delivery that this accreditation program signifies?

Griffin: Well, the title may be fairly new, but the work has been around for years and years. When I was speaking at Jefferson earlier this week, I referenced that when I was in medical school from 1990 to 1994 we were facing the AIDS epidemic. There were definitely people who were ambassadors from communities, who were acting as those liaisons during that time. And we saw this during the COVID epidemic, when there were people in marginalized communities, or communities without access, who stepped into that role. What I saw at Jefferson is just absolutely outstanding. They have a fantastic program there. I think that the focus and dedication that Jefferson has demonstrated in the development and support of this role is a new, higher level of the community health worker connection.

HCI: What were some things that URAC was hearing from health systems about the potential value of creating an accreditation program around CHW programs? 

Griffin: Actually, we were approached by community health worker-leading organizations. The motivation at the time was that there was a payment mechanism that the federal government had implemented for community health workers. When that happened, the community health worker leaders were telling us that they were very concerned that this label was going to get slapped on people who were not actually community health workers, and that there was a risk of their true function getting corrupted a little bit. 
They said they would like URAC — as a trusted, independent organization — to help them protect what's really good and true about community health workers.

HCI: Are health systems and payers also looking to have better-defined roles and more standardization around things like training? 

Griffin: From an organizational standpoint, people want help in defining what a good program looks like. Because this is not something where you just give somebody a new name badge and call them a community health worker, and suddenly their lives have changed. We partnered with many people within the community health worker space to help them define what makes this a real career, a real engaged role within the healthcare system. Our program talks about things like training, supervision, and workload. It talks about a career path. It also sets out some terms around how the community health worker needs to be integrated into the care team. It's really supposed to make sure that this is connecting people in the community with resources that they might not other have access to, but also to make sure that this person is part of the team. 

HCI: What's happening at the state level with CHW certification? I think I read that some states have certification programs and others don't. Does that tie into accreditation? 

Griffin: When we look at certification vs. accreditation, certification typically applies to an individual’s qualifications. I think certification plays a role, but this is about the program and how it should take care of the individuals. The individuals may face different rules for certification depending upon which state they work in. By creating a national program, we’re showing the community health workers what a good program looks like, no matter where they are in the country.

HCI: Chris, why did Jefferson want to go through this accreditation program with URAC? What does it signify to partners in the community, to people interested in applying for these roles, or to payers?

James: When the program was first announced, I looked into it and thought that we're probably doing 85% of these things already. I really felt  it was an opportunity, not just for insurance and billing purposes, but just this validation externally — like an independent auditor to come and see how we're doing and to recognize that. And I thought that would be helpful in everything from recruitment into our program to making sure that people know that we support our CHWs by using best-practice standards. 

HCI: Could you talk about your background and role and the inception of the CHW Academy at Jefferson?

James: I have a master's and a Ph.D. in social work, and I've worked in state government and the nonprofit sector. Jefferson had private philanthropists who invested funds to start this CHW Academy about three and a half years ago, and I thought it was a perfect fit and reminded me why I went into social work. When I came to Jefferson, there was some training, but it wasn't a formalized CHW Academy like we have now. We had a handful of CHWs in a couple of programs at Jefferson, but we didn’t have the kind of infrastructure that is in place now.

HCI: When you set up this academy, how did you decide the levels of training that would be necessary and whether people needed to have a certification or not? Did you look at other programs around the country?

James: I looked locally, because Philly has large healthcare systems and programs. I saw some gaps in training and we also had to make sure that we were in alignment with the Pennsylvania certification board, and they have very specific criteria. 

HCI: Do all of the people who go through the academy get the state certification?

James: Yes, because in our immersive program, which is 13 months long, you get the training that the state requires. You get the year-long work experience, and you get the supervision hours. You get everything so that you're graduating with that certificate in hand. We also started an accelerated CHW Academy for people who are already working as CHWs but hadn’t had the chance to get the training they need to get that certification.

HCI: Earlier, you said you felt like your program was already doing around 85% of what the accreditation was requiring. What were some things you had to do that you weren't already doing?

James: We were doing a lot of things that weren't written down, so we had to have much more formal policies and policy manuals for all the roles. Also, this was the impetus to create a formal mentorship program and get more formal about the metrics. The reviewers suggested we try to consolidate some of this and make it more  cohesive, so we learned through the process some things that were helpful in making us more efficient and effective in what we were doing.

HCI: In addition to primary care, are some of the CHWs at Jefferson assigned to work in hospital emergency departments?

James: Yes, we do have CHWs in emergency departments. They’re helping folks who are coming in for social needs that are unaddressed and trying to connect them back to resources. We have a CHW who works in a trauma intervention program in the Jefferson Einstein hospital. His job is to meet people who have been victims of shootings, stabbings, and assaults of different kinds. He meets that person in the ED and makes that connection, Then as they leave the hospital,  he helps them with resources. If they get admitted, he works with the family and others to try to help that person.

HCI: Jefferson has stated that this program has already helped reduce ED visits and readmissions and improved blood pressure control. Does the health system try to create metrics to measure the impact of the CHW program?

James: We’re really in the throes of pulling that data out of Epic. A sample we pulled looked at the timeframe six months before working with a CHW and six months after, and found that it brought down no-show rates, increased PCP visits, led to reductions in avoidable ED visits and patient admissions. We’re going to expand on that sample. We have seen the literature about the impact of these programs, but as in any healthcare organization, they want to know is that happening here, too? 

For instance, we have a blood pressure buddy program. Community health workers who are fully community-based get referrals from primary care practices with folks who have uncontrolled hypertension. They go into the home and help them get the automated blood pressure cuff set up, show how to do the measurement, how to use MyChart to message what the blood pressure is. They do that in collaboration with nurse care coordinators. We have pulled sample data that definitely showed some increase in control. But now we’re going to look at that specific CHW piece to see how invention helps. 

HCI: You graduate around a dozen CHWs from your academy each year. Could you see that number growing eventually?

James: We’ve decided that bringing in about a dozen or so a year is actually the pace that we should stick with right now, because it helps us be really intentional and make sure they're well-trained and we can find placements that make sense for that person post-graduation. But it could expand in the future because Pennsylvania is coming out right now with rules around billing for Medicaid. That hasn't existed for Medicaid here before, and most of our CHWs are working with the Medicaid population. While I won't make changes for this year, because I have 12 people coming in on May 18, I will keep an eye on that, because that could mean positions are added at a faster pace.  

HCI: Have you spoken to people in similar positions at other health systems who might be considering going through this URAC accreditation process? 

James: Yes, I've gotten connected through a health management academy to people across all different healthcare organizations — in Texas, Indiana and Florida. I'm having conversations with folks who are just setting up these programs and trying to figure out how to do that. But there are other very established programs with 100 CHWs. I think they're the ones that are going to realize they have the infrastructure to go through this process. And the newer programs will have this list of 10 standards to better understand where to start.