CHWs Changing Outcomes in South Carolina
Over the last decade, the refocusing of healthcare to quality- and outcome-based approaches has demonstrated a myriad of positive outcomes – particularly those related to returns on investment and improvements in patients’ health. Though these types of approaches are becoming more recognized, the transition has been a slow and inconsistent one. In the meantime, healthcare costs continue to rise, and health disparities remain apparent. South Carolina is not excluded from these changes and challenges. While addressing these issues is complex, there are evidence-based approaches that the state is in a prime position to begin implementing. One such approach involves the employment of community health workers (CHWs).
As the evidence demonstrating the impact CHWs have on health outcomes and spending continues to expand, we must intentionally move toward sustainable ways to support this critical workforce. Currently, CHWs in South Carolina are mainly funded by “program” or “project” grants and contracts that are often short term, subject to appropriations or private philanthropic decisions, and focused on specific, time-limited goals.
For South Carolina’s residents to reap the benefits and cost savings of CHWs employed at their full capacity, we need a budgeting mechanism for CHW positions that is not dependent on applying for grants, and that creates stability and sustainability for these programs throughout South Carolina.
James R. Clark Memorial Sickle Cell Foundation
Following initial funding from the South Carolina General Assembly, this initiative has been renewed for a second year with funding provided by the South Carolina Department of Health and Human Services to support an expanded focus on addressing existing health inequities in our state and reducing cost of care through the creation of a Community Health Worker (CHW) Pilot Program. Funding for this pilot is being implemented by the Center for Community Health Alignment (CCHA) with evaluation conducted by the Center for Rural and Primary Healthcare (CRPH). CCHA has partnered with organizations across the state to improve the health of underserved individuals in South Carolina through Community Health Workers (CHWs).
In Year 1 (2021-2022), the pilot funded twenty-one (21) CHWs across 12 organizations located statewide, as well as three additional technical assistance providers. CCHA identified and selected these sites, provided ongoing technical assistance to support effective CHW models and data collection, oversaw project implementation, and coordinated communication between administrative and participating entities.
Data captured in the initial 1-year period reflected over 2,500 patients served through nearly 5,000 separate encounters. CHWs provided a range of services, including, but not limited to: application assistance, referrals to support identified social determinants of health, vaccine scheduling, patient advocacy, community and patient relationship building, and health education. The first annual report will be provided by the CRPH evaluation team in early 2023.
Year 2 (2022-2023) data collection will continue through October 31st, 2023. Alongside the addition of a new health topic, perinatal health, twenty-three (23) CHWs from 14 community organization partners will help improve the health of South Carolinians, with coverage in all 46 counties.
CCHA is maintaining the same roles as in Year 1, with the addition of assuming administrative responsibilities. CCHA and CRPH will support partners in continuing to demonstrate the ongoing, day-to-day impact of CHWs; corresponding data collected during the pilot period is expected to translate to improved long-term health outcomes and decreased medical spending.
We also currently have a five-year plan, which encompasses one more year of the pilot followed by proposed policy changes that allow for the expansion and sustainability of CHW services.
Priority Health Topics
At the start of the Year 2, participating organizations chose to focus on one or more of the following priority health topics most relevant to the needs of the communities they serve:
- Diabetes (Type II)
- High Need/High-Cost Service Use
- Pediatric Asthma
- Perinatal Health
- Sickle Cell Disease
Organizations were encouraged to select topics that aligned with their existing CHW workflows. Thanks to continued pilot funding, the Perinatal Health topic was included for the Year 2 project scope.
Data to be collected across sites as appropriate include, but are not limited to:
- Number of individuals reached
- Zip code of individuals’ residence
- Needs identified in screening
- Medicaid claims data
- Patient self-efficacy
- Patient satisfaction
- Patient demographics
- Referrals to health and social resource
Additional data specific to each selected health topic is also being collected.
Expected 2-Year Outcomes
- Increased number of individuals served in underserved areas of the state
- Increased access to social and health resources through community referrals and follow-up
- Increased scheduling of infant and youth immunizations
- Increased access to care for individuals with Sickle Cell Disease
- Increased utilization of primary and preventive services by individuals with Type II diabetes and high need/high-cost healthcare utilization
- Increased access to perinatal health services and resources
Partnerships and CHW Coverage
*Additional partners not listed on CHW coverage map:
- The Center for Rural and Primary Healthcare (CRPH; evaluation services, Year 1-present)
- The South Carolina Hospital Association (SCHA; technical assistance provider for AccessHealth sites, Year 1-present)
 Rush C. (2018) Sustainable Financing of Community Health Worker Employment. National Association of Community Health Workers. https://nachw.org/wp-content/uploads/2020/10/SustainableFinancingReportOctober2020.pdf