title: Integrating community health workers within Patient Protection and Affordable Care Act implementation.
abstract: BACKGROUND
  The Patient Protection and Affordable Care Act's (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs.
  
  
  OBJECTIVE
  This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration.
  
  
  RESULTS
  Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers' role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers' unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs.
  
  
  CONCLUSIONS
  Community health workers can support the effective implementation of PPACA if the capacity and potential of CHWs to serve as cultural brokers and bridges among medically underserved communities and health care delivery systems is fully tapped. Patient Protection and Affordable Care Act and current payment structures provide an unprecedented and important vehicle for integrating and sustaining CHWs as part of these new delivery and enrollment models.
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, New York (Drs Islam, Kwon, and Trinh-Shevrin); NYU Prevention Research Center, New York, New York (Drs Islam, Kwon, and Trinh-Shevrin and Ms Nadkarni); NYU Center for the Study of Asian American Health, New York, New York (Drs Islam, Kwon, and Trinh-Shevrin and Ms Nadkarni); Health Management Associates, New York, New York (Ms Zahn); and NYU Robert F. Wagner School of Public Service, New York, New York (Ms Skillman).
authors.forename: Nadia
authors.initials: N
authors.lastname: Islam
authors.forename: Smiti Kapadia
authors.initials: SK
authors.lastname: Nadkarni
authors.forename: Deborah
authors.initials: D
authors.lastname: Zahn
authors.forename: Megan
authors.initials: M
authors.lastname: Skillman
authors.forename: Simona C
authors.initials: SC
authors.lastname: Kwon
authors.forename: Chau
authors.initials: C
authors.lastname: Trinh-Shevrin
mesh_terms: D003150:Community Health Workers; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D058991:Patient Protection and Affordable Care Act; D011320:Primary Health Care / Q000379:methods*; D016730:Program Development