How Structured CHW Programs Drive Real Outcomes for Safety-Net Health Plans

Across the country, health plans are investing in Community Health Worker (CHW) programs to better address health-related social needs (HRSNs). It's well established that social determinants of health (SDOH)—such as housing, food access, transportation, and employment—significantly influence health outcomes, often more so than clinical care alone.

CHWs are uniquely positioned to bridge this gap. They bring lived experience, cultural alignment, and trust to communities where traditional care teams often struggle to engage. However, the impact of CHW programs varies dramatically depending on how they are implemented.

Why Structure Matters

CHW programs often start with enthusiasm but may lack a clear framework. Without structure, outreach can feel disorganized, screenings become inconsistent, referrals may not succeed, and measuring results proves challenging.

In contrast, structured, evidence-based CHW programs are designed to:

• Target and engage the right members at the right time
• Use validated tools to identify actionable social needs
• Build trust through consistent and sustained contact
• Collaborate with care teams to close gaps in care
• Track outcomes and demonstrate cost-effectiveness

The difference between these two approaches can be the difference between modest, short-term results and lasting, measurable impact for both members and health plans.

Real Outcomes from Structured Programs

When CHW programs are structured effectively, the outcomes speak for themselves:

• Engagement rates approaching 90% among high-need populations
• Faster identification of actionable social needs
• Two to three times improvement in successful service connections
• Stronger care plan adherence and reduced gaps in care
• Documented cost savings per member through reduced utilization

These results aren't theoretical; health plans and community-based programs across the U.S have demonstrated these outcomes.

A California Example

California's CalAIM initiative has provided a powerful proving ground for this work. With billions invested to integrate social needs into Medi-Cal, health plans have been tasked with expanding Enhanced Care Management (ECM) and Community Supports.

Plans that approach CHWs with structure—embedding them in care teams, tracking outcomes, and building referral loops—have shown significant improvements in member engagement and system efficiency. This demonstrates the potential for similar programs nationwide when designed intentionally.

Why This Matters for Safety-Net Plans

For safety-net health plans, the stakes are particularly high. These plans serve the populations most affected by health inequities and hold accountability for outcomes and resource use. A well-structured CHW program isn't just another initiative; it's a strategic investment in:

• Reducing disparities
• Strengthening member trust
• Improving performance on quality metrics
• Achieving financial sustainability under value-based models

Moving Forward

The evidence is clear: CHW programs lacking structure typically deliver activity without meaningful results, while structured CHW programs produce real outcomes.

For health plans, now is the time to implement frameworks that allow CHWs to do what they do best: connect, coach, and transform care.