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[1].

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.

Project Goals

This pilot, funded by the South Carolina General Assembly, is being implemented by CCHA and the South Carolina Community Health Worker Association (SCCHWA), with evaluation conducted by the Center for Rural and Primary Healthcare (CRPH). CCHA and SCCHWA have partnered with organizations across the state to improve the health of underserved individuals across South Carolina through Community Health Workers (CHWs).

Data captured in this initial 1-year period (through November 2022) is reported quarterly to CCHA and CRPH and is intended to show intermediate outcomes which are expected to translate to significantly improved health outcomes and decreased medical spending. Twenty-one (21) CHWs will help improve the health of South Carolinians in all 46 counties.

We also currently have a five-year plan, which encompasses two more years of the pilot followed by proposed policy changes that allow for the expansion and sustainability of CHW services.

Our Approach

Priority Health Topics

At the start of the initial pilot year, 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:

  • COVID-19 Vaccination
  • Pediatric Asthma
  • Diabetes (Type II)
  • Sickle Cell Disease
  • High Need/High-Cost Individuals

Organizations were encouraged to select topics that aligned with their existing CHW workflows. Pending continued pilot funding, additional health topics will be included within the project scope.

General Indicators

At the start of the initial pilot year, 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:

  • Number of individuals reached
  • Zip code of individuals’ residence
  • Needs identified in screening
  • Number of emergency department visits
  • Patient self-reported health status
  • Patient self-reported quality of life
  • Patient satisfaction
  • Patient demographics

Additional data specific to each selected health topic is also being collected.

Expected 1-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 to ensure resource connection
  • Increased acceptance of, knowledge of, and access to COVID-19 vaccines
  • 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

Partnerships and CHW Coverage

[1] Rush C. (2018) Sustainable Financing of Community Health Worker Employment. National Association of Community Health Workers.