A PechaKucha presentation by Kimberly Zill at the National Rural Assembly 2013

1. Best Practices:
Community Health
Workers and Positive
Impact on Community
Change
Grassroots impacts of Community
Health Workers, Promotoras and Lay
Health Workers in relation to the
upcoming roles of Patient Navigators
with the Affordable Care Act.

2. Arizona Rural Women’s Health Network
Members
• Eastern Arizona Area Health
Education Center
• Greater Valley Arizona Area
Health Education Center
• Northern Arizona Area Health
Education Center
• Western Arizona Area Health
Education Center
• Mogollon Health Alliance
• Time Out, Incorporated
• Arizona Department of Health
Services
• Mariposa Community Health
Center
• Arizona Alliance for Community
Health Centers
• Arizona Office of Rural Health-
University of Arizona-MEZCOPH
• Payson Chapter Amnesty
International

3. The Role of The Community Health
Worker or Promotora
Community Health Workers (CHWs) are frontline public health
workers who are trusted members of and/or have an unusually close
understanding of the community served. This trusting relationship
enables CHWs to serve as a liaison/link/intermediary between
health/social services and the community to facilitate access to
services and improve the quality and cultural competence of service
delivery. CHWs also build individual and community capacity by
increasing health knowledge and self-sufficiency through a range of
activities such as outreach, community education, informal
counseling, social support and advocacy. (APHA)

4. The Promotora Model
Spanish word for “promoter” and in
this context also can refer to
community health workers.
Promotoras live in the communities
in which they work. They are the
knowledge keepers for that
community. They are not usually
formally educated, but serve as a
wealthy of knowledge for those
people needing to access services in
the community. They are trusted
advisors, educators and able to
reach those in underserved areas.

6. The Definition of the CHW or Promotora can be
broad- however is built on these core
definitions:
1. Bridging and providing cultural
mediation between communities
and health and social service
systems
2. Providing culturally appropriate
health education and information
3. Ensuring people get services
they need
4. Providing informal counseling
and social support
5. Advocating for individual and
community needs
6. Providing direct service, such as
basic first aid and administering
health screening tests
7. Building individual and
community capacity

7. Why is the Promotora/CHW/CHA Model
Considered a Best Practice?
The National Community Health Advisor
Study, conducted by the University of
Arizona, found an array of benefits associated with
CHA outreach & education services in underserved
communities, such as decreases in ER visits, a
reduction in the length of hospital stays, and fewer
medical complications when patients do receive
medical attention. Because CHA outreach focuses on
the individual, services are provided in a cost-
effective and culturally sensitive manner that
eliminates many barriers that prevent some from
obtaining medical care. As a result, a greater sense
of trust develops between the community and the
formal health care system.

8. Community Capacity
Opportunities
 Communities can benefits from new
leadership. CHWs & Promotoras are
usually very well respected community
members and can help with capacity
building.
 The Promotoras/CHWs are positive
representatives of their respective
agencies and will act as advocates for
the community.
 Both CHWs & Promotoras are well
versed in the assets and needs of their
communities.

10. Amazing Community Health Worker and
Promotora Work here in Arizona!

11. ACA: Marketplace - Patient Navigators
•Each Marketplace is required to have at least two (2)
types of entities serve as Navigators- one (1) must be
a community and consumer focused non-profit
• Must be trained to ensure they have expertise in the needs of
underserved and vulnerable populations (e.g. rural, people living
with HIV/AIDS)
• Navigator grantees could include individuals and organizations
that often target their outreach to specific ethnic, geographic or
other communities although all Navigators should have ability to
help any individual who seeks assistance

13. Navigator Eligibility
• Eligible entities:
• Self employed individuals
• Public and private entities including non-profit
organizations, tribes and tribal
organizations, unions, chambers of commerce, etc.
• Ineligible entities:
• Health insurance issuers and their subsidiaries
• Associations that include members of, or lobbies on
behalf of, insurance industry
• Recipients of any direct or indirect consideration from
health insurance issuer in connection with enrollment

14. Navigator Program Management
•In the Federal Marketplace- HHS funds and
awards funding for Navigator grants
•States choosing to build their own Marketplace
will build their own Navigator programs
including awarding and overseeing
grants, developing standards and ensuring
adherence to programmatic requirements

16. Non- Navigator Assistance Personnel
(In-Person Assistance Personnel)
•A “non-Navigator assistance program” is a
program established to fulfill consumer
assistance, education and outreach
functions.
•HHS does not anticipate operating
non-Navigator assistance programs in the
FFM.

18. CACs in the Marketplace
• Certified Application Counselor.
What does this mean to us and those we serve?
• States building own Marketplace- Navigator and CAC, but may choose
whether or not to have a non-Navigator assistance program.
• States working with CMS- Must have a Navigator, non-Navigator
assistance program and a CAC program.
• The Federal Marketplace- Navigator program, CAC program, but is not
anticipated to have non-Navigator assistance personnel.

19. Get the latest resources to help people apply, enroll and
get coverage at- Marketplace.cms.gov

20. Thank you!
Kim Zill, MS
Network Director
Arizona Rural Women’s Health Network
kimberlyz@aachc.org
700 E. Jefferson St. | Suite 100 | Phoenix, AZ 85034
Phone: 602-288-7544 | Fax: 602-252-3620