A Smarter Way to Build Your Care Team

Across the country, health systems, clinics, and community health organizations are rethinking what a care team looks like. This shift isn't driven by desperation. It's driven by a growing recognition that the traditional model was never designed to meet patients where they actually are.

A Different Kind of Provider

Community Health Workers. Peer Support Specialists. Doulas. Community Paramedics. These roles have existed in various forms for decades, but they're having a genuine moment, and for good reason.

What makes them different isn't just that they extend the reach of a care team. It's how they extend it:

• Community Health Workers help patients navigate social determinants of health alongside clinical needs, providing sustained, culturally-grounded support

• Peer Support Specialists bring lived experience with mental health or substance use recovery to patients facing the same challenges

• Doulas provide continuity through pregnancy and postpartum, particularly valuable for high-risk patients who need more than episodic clinical contact

These aren't workarounds. They're a genuinely better fit for a meaningful slice of care delivery.

Healthcare organizations that are building these roles into their teams aren't compromising on quality. They're being precise about who is best positioned to deliver what kind of care.

The Policy Is Finally Catching Up

For a long time, the challenge with these roles was financial sustainability. Doing meaningful community health work on grant funding alone is precarious, and organizations built on grants don't scale.

That's changing, and the pace of change is worth paying attention to.

• In January 2024, CMS introduced the first-ever Medicare billing mechanism for CHW and Peer Support services, reimbursing approximately $79/hour for Community Health Integration and Principal Illness Navigation services.¹

• 20+ states have approved Medicaid State Plan Amendments covering CHW services.²

• All 50 states reimburse Peer Support Specialists through Medicaid

• 15+ states have active Doula coverage through Medicaid, with more expanding rapidly.³

The financial infrastructure to sustain this workforce is being built in real time. Organizations that are moving now are positioning themselves ahead of a curve that is only going to keep rising.

Why This Is a Hiring Strategy, Not a Compromise

It's worth being direct about something: expanding your care team with CHWs and adjacent providers isn't a budget workaround. It's a legitimate workforce strategy, and one that happens to be well-suited to this moment.

The clinical evidence is solid:

• CHW interventions are associated with reduced ED utilization, better chronic disease management, and improved treatment follow-through

• Peer support models have demonstrated meaningful outcomes in behavioral health and substance use recovery

• Doula support is linked to better birth outcomes, especially for Black and Indigenous birthing people who face disproportionate maternal mortality risk

These are outcomes the healthcare system has been trying to move for years. The workforce to help move them is available, increasingly well-trained, and now reimbursable. That last part is new, and it changes the calculus entirely.

The organizations figuring this out aren't just filling seats. They're building care teams that are better matched to their patient populations, more connected to their communities, and more sustainable financially than a model that relies entirely on clinical staff to do everything.

The One Thing to Get Right

The opportunity is real. The policy support is real. And like any workforce expansion, the key to making it work is getting the operational foundation right.

Because this workforce is relatively new to the formal billing system, the enrollment and credentialing landscape is more complex than for traditional clinical providers:

• Every state has its own certification requirements, billing codes, and payer enrollment processes

• Supervision and billing relationships need to be structured correctly from the start

• Community-based organizations new to Medicaid billing need a clear path from hiring to reimbursement

None of that complexity is a reason to hesitate. It's just a reason to go in with a plan. The organizations thriving with this model are the ones who treated the operational setup with the same intentionality they brought to the hiring decision itself.

Get the infrastructure right, and this workforce does exactly what the evidence says it does. It improves outcomes, extends your reach, and builds the kind of patient relationships that keep people engaged in their care.

That's not a workaround. That's a better way to build a care team.

If you're building out one of these roles and want to make sure your credentialing and enrollment foundation is set up correctly from the start, we can help.

¹ CMS Calendar Year 2024 Medicare Physician Fee Schedule Final Rule, via ASTHO. G0019 national payment rate approximately $79/hour (non-facility). Effective January 1, 2024.

² NASHP, "Updates and FAQs: Developing and Implementing a Medicaid State Plan Amendment to Authorize Community Health Worker Reimbursement," April 2025.

³ Prenatal-to-3 Policy Impact Center, "Community-Based Doulas," September 2024. As of September 2024, 20 states including D.C. actively cover doula services under Medicaid, with six more in the process of implementing coverage.