Written by Amantha Bagdon

We can all relate to the following scenario. The phone rings incessantly as you scramble to fill prescriptions, answer patient questions, and coordinate insurance approvals. It is just another day at the pharmacy. A visibly exhausted patient approached the counter, clutching a handful of papers. They complain about being in and out of multiple healthcare facilities, trying to find help for their aging father, who has diabetes, hypertension, and early signs of dementia. They are clearly overwhelmed, frustrated, and exhausted from the maze of healthcare navigation.

I find myself thinking about all the patients who struggle daily—not just with their prescriptions but with the underlying factors that impact their health: housing insecurity, food access, social isolation, and financial stress. Many in our profession find our possible roles in pharmacy to be so much bigger. What if we weren’t just dispensers of medications? After all, we are often the most accessible healthcare professionals in our communities. What if we could do more to bridge the gaps our patients face?

The concept of community health workers (CHWs) first made it onto my radar when I attended McKesson’s Ideashare in 2023. I haven’t been able to stop thinking about how pharmacies are uniquely positioned to incorporate these services as both a revenue stream and a value-add for communities. I have to take a moment to shout out the deep admiration and respect I have for a fellow pharmacy technician, who executed this strategy for their pharmacy, Rachel Miller! Indeed, pharmacy technicians are a natural fit to serve in CHW roles in the pharmacy.

What Are Community Health Workers?
CHWs are trained, nonlicensed professionals who provide crucial preventive health services to improve patient outcomes, reduce healthcare disparities, and address social determinants of health (SDOH). In California, the Department of Health Care Services (DHCS) recognized the value of CHWs by adding CHW services as a Medi-Cal benefit that began July 1, 2022. On July 26, 2024, DHCS received federal approval to include CHW services as a benefit under Medi-Cal Dental, effective December 1, 2024.

CHWs help address a variety of health concerns, including the following:

• Chronic disease management (diabetes, hypertension, asthma)
• Behavioral health support (mental health education, substance use navigation)
• Preventive health education (smoking cessation, vaccinations, nutrition counseling)
• Maternal and perinatal health (supporting expecting and new mothers)
• Violence and injury prevention (community violence intervention, domestic abuse resources)
• Health navigation (helping patients access resources, schedule appointments, understand insurance options)

Why Pharmacies Are the Perfect Fit for CHW Services
Pharmacies already serve as community healthcare hubs. Patients visit more frequently than they do primary care providers, making pharmacies a natural t for CHWs. Here’s why pharmacies should integrate CHW services:

1. Pharmacies Have Trusted Relationships
   Patients already trust their local pharmacists and pharmacy technicians. By incorporating CHWs, pharmacies can build on this trust and offer holistic patient care.
2. Additional Revenue Stream
   Effective October 1, 2024, pharmacies can bill for CHW services using CPT codes 98960, 98961, and 98962. Pharmacies that integrate CHWs can receive reimbursement from Medi-Cal and managed care plans (MCPs), increasing revenue while providing valuable services.
3. Addressing SDOH
   Many patients struggle with nonmedical barriers to care. CHWs can assist with:

• Medication adherence support
• Coordinating transportation for medical visits
• Connecting patients to food assistance programs
• Helping uninsured patients access financial aid

How to Incorporate CHWs into Your Pharmacy
1. Define Clear Objectives & Key Results (OKRs)
Just like any new service, setting clear goals ensures success. Here’s an example:

Objective: Successfully integrate CHW services into the pharmacy.

Key Results

• Have at least 1 CHW on the pharmacy staff with 6 months, either through retraining current staff or hiring an already-qualified CHW.
• Increase patient adherence rates by 10% through CHW interventions.
• Conduct monthly health education sessions with at least 20 attendees.
• Secure one new contract with MCPs for CHW reimbursements.

2. Train Pharmacy Staff
Pharmacy technicians are a natural fit for CHW roles. Many already assist with medication adherence, patient education, and insurance navigation. Training pharmacy technicians as a CHW can:

• Enhance their skill set.
• Provide career advancement opportunities.
• Improve patient relationships and health outcomes.

3. Secure Reimbursement Contracts
Enroll in Medi-Cal’s PAVE portal to become a certified provider. Contracts with MCPs allow pharmacies to bill for CHW services and secure long-term funding.

Examples of CHW Services in a Pharmacy Setting

1. Diabetes Self-Management Education

• CHWs can provide one-on-one coaching to diabetes patients, helping them understand glucose monitoring, nutrition, and lifestyle adjustments.
• Billing Code: CPT 98960 (individual coaching)

Call to Action
Are you ready to expand your pharmacy services and tap into CHW reimbursement? Start by enrolling in a CHW training program or contacting MCPs for partnership opportunities. Let’s redefine pharmacy care—one patient, one service, and one community at a time.

If you want help setting up CHW services in your pharmacy, please contact me at amantha@rx-post. com with the subject line CHW Interest. We can do this – like Rachel did!

2. Medication Adherence and Chronic Disease Management

• CHWs call high-risk patients monthly to ensure they are taking medications correctly and check for adverse effects.
• Billing Code: CPT 98961 (small group coaching, 2-4 patients)

3. Community Wellness Events

• Hosting blood pressure screenings, influenza shot clinics, and health fairs with CHW-led education.
• Billing Code: CPT 98962 (group education, 5-8 patients)

4. Social Isolation Interventions (Yes, Even Bingo!)

• CHWs organize community activities such as bingo nights, which can reduce social isolation and improve mental health.

Empowering Pharmacies for the Future

Key Stakeholders in a Successful CHW Program

• Pharmacy Owners and Managers: Oversee contracts and financial sustainability.
• Pharmacy Technicians: Train as CHWs to expand their roles.
• MCPs: Partner for patient referrals and reimbursement.
• Community Organizations: Collaborate for outreach and education initiatives.

How to Foster Accountability:

• Assign leadership: A designated CHW program lead ensures goals are met.
• Track outcomes: Use patient adherence rates, reduced hospitalizations, and community engagement metrics.
• Regular check-ins: Conduct team meetings to review progress and adjust strategies.

Final Thoughts: The Future of Pharmacy with CHWs
Pharmacies have always been pillars of the community, but now they have an opportunity to expand their role in healthcare delivery through CHWs. By integrating CHWs, pharmacies can:

• Enhance patient care
• Increase revenue streams
• Reduce health disparities

This is not just a new business model— it’s a paradigm shift in pharmacy care. By taking the lead in integrating CHW services, pharmacies will become even more essential to the communities they serve.