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Emcara Health Q&A: Community Health Workers Serve Important Role in Responding to Rural Healthcare Crisis


Emcara Health Editors


October 16, 2023


It is common knowledge that we are facing severe healthcare shortages, specifically in rural areas. While only 14 percent of Americans live rurally, these communities represent nearly two-thirds of primary care health professional shortage areas in the U.S. These shortages exacerbate all kinds of issues, including unmet behavioral health needs and higher emergency department utilization among rural patients.

In an earlier blog, we discussed the rise of Community Health Workers (CHWs) and how this role is pivotal for patients by consistently assessing needs, setting personalized action plans and making connections to the right resources. But how do we most effectively deploy this resource in support of rural patients?

Susie Martinez, senior manager and the national lead for Emcara Health’s CHW team, recently participated in an Association for Affiliated Community Plans (ACAP) webinar where she discussed strategies for improving care access in rural settings by fully integrating CHWs into multidisciplinary teams. Here are a few highlights from the discussion. You can view the full presentation by clicking here.

Can you start by sharing some of the common barriers facing patients in rural settings?

Many of the often-discussed barriers include things like geographic isolation and lack of public transportation, low health literacy and limited availability of bilingual providers and language services. Poor broadband access is also prevalent, which makes receipt of care via telehealth a challenge. And then there's another big challenge that isn’t discussed as frequently. I’m talking about the social stigma and lack of privacy experienced by those living in rural areas as it pertains to getting care. In a small town, everyone knows your business. So, trying to find ways to help people feel more comfortable about getting care is just another obstacle.

So, we have two challenges here it seems. The first is creating access to care, and the second is helping individuals trust the care they can access. Where do we start?

There are many pieces to this puzzle. An important one is the role of the CHW as a key member of care teams. CHWs can help make connections to available resources, but they also can be at the forefront of building trust with patients as well. CHWs are very effective at nurturing relationships with patients and helping them open up and be honest about their struggles and what social barriers are getting in the way of their care. When you have a CHW working closely with the clinical team, you are much more likely to deeply engage patients and solve for their most critical needs.

Trust has to be earned, though. I’m assuming it is a process to develop trust with patients?

Building trust at the very beginning can be very challenging. It takes time. If the CHW can communicate their role clearly and explain how they are going to help the patient, that’s a great starting point. Motivational interviewing is a skill that is critical to building this trust. What we see over and over is that if the CHW continues to show up, delivers on promises and educates the patient, trust is achieved.

How do CHWs know which community resources are available to support individuals?

Sometimes, you start with a list that has been compiled by your client, but if you ask any community health worker out there, they’ll likely tell you they find most of the resources they use while doing their own research. Part of a CHW’s responsibility is to invest time researching and learning what’s available in their community and sharing those connections with the rest of their team. It is a never-ending process. CHWs are constantly finding new resources, adding them to the list and sharing among themselves.

How do you ensure a smooth transition for a patient once a referral has been made?

You always follow up, no matter what. You should never just provide a resource to a patient and move on without closing the loop and ensuring they were able to connect. The proper course is to provide the resource and then walk the individual through the steps and follow up to ensure everything is going according to plan. You need to do this to facilitate a smooth transition and also place some accountability on the individual to follow through with the help that is offered.

In many cases, a CHW can help identify the root causes for patients who are not compliant with appointments or care plans. This can result in multiple benefits for both patients and providers. Can you provide a specific example of this impact?

We’ve seen patients who are not able to attend specialist appointments because they have no means of transportation. The specialists don’t know this, so they administer cancellation fees and ultimately drop some patients. These patients now have additional financial strain from these fees and have to find another specialist, who is likely even farther from their home. These patients had every intention of making their appointments. Having a CHW to advocate for them and to make sure the specialists understand why they didn’t make appointments is invaluable. Instead of being fined and dropped, the conversation centers on how we can help them make their appointments.

How do you measure the success of CHW interventions?

The best way to measure success is by verifying you are closing gaps and social barriers the patient is facing. When a patient’s social needs have been appropriately addressed, you graduate them. If you graduate a pre-determined percentage of patients with social needs, you can declare the program is successful. This is a straightforward, yet powerful, way to measure and prove impact.

What are your recommendations for selling leadership on the idea of adding CHWs to care teams?

Leadership can sometimes be hesitant to invest in new resources and approaches. With CHWs, it can be as simple as helping them understand how this role can effectively connect individuals to resources and address many of the underlying issues that are preventing patients from adhering to care plans. When you lay out all the ways a CHW can positively impact patient outcomes, it quickly becomes an obvious opportunity that leadership can support.

The role of a CHW seems to be crucial to an effective approach for rural populations. What’s next for the CHW profession?

A big next step is certification. This is important because it builds credibility in the profession. Individuals are more likely to trust a CHW if it is a credentialed, certified role. This is true for patients, but also for community organizations and providers. We are seeing increasing momentum across states for certifying CHWs, and I hope this continues.

Want to learn more about using CHWs as part of a multidisciplinary care team to reach rural individuals? Contact us today at for a personal consultation. You can also sign up for our newsletter to stay up to date on Emcara Health news.

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