Jasmine Gonzalvo, PharmD, MPH, CDCES, FADCES, and Honey Yang Estrada, MPH, CHW, join this episode to discuss the vital role of community health workers (CHWs) in diabetes care. They share strategies for recruiting CHWs, integrating them into interprofessional care teams, and leveraging their lived experience to build trust and address barriers beyond the clinic walls. The conversation emphasizes listening to CHWs, fostering sustainable partnerships, and shifting power to communities—not just checking a box—to reduce disparities and drive better outcomes.
Jasmine Gonzalvo, PharmD, MPH, CDCES, FADCES, and Honey Yang Estrada, MPH, CHW, join this episode to discuss the vital role of community health workers (CHWs) in diabetes care. They share strategies for recruiting CHWs, integrating them into interprofessional care teams, and leveraging their lived experience to build trust and address barriers beyond the clinic walls. The conversation emphasizes listening to CHWs, fostering sustainable partnerships, and shifting power to communities—not just checking a box—to reduce disparities and drive better outcomes.
Angela Forfia
Hello and welcome to ADCES' podcast, The Huddle, Conversations with the Diabetes Care Team. In each episode, we speak with guests from across the diabetes care space to bring you perspectives, issues, and updates that elevate your role, inform your practice, and ignite your passion. I'm Angela Forfia, Director of Prevention and Public Health Initiatives at the Association of Diabetes Care and Education Specialists. I co-lead the MATCH Initiative's Training and Technical Assistance Corps.
Our guests today are Jasmine Gonzalvo and Honey Estrada, and they'll be talking about community health workers and how we can better integrate them into health system teams and partner with them for better health outcomes and care. Jasmine and Honey, welcome to The Huddle.
Jasmine Gonzalvo
Thanks for having us.
Angela Forfia
Before we dive in, can you introduce yourselves, tell us a little bit about your background, your role in healthcare, and what inspired your work with diabetes care, and community health workers.
Jasmine Gonzalvo
Yeah, hi, this is Jasmine. currently serve as the president of the Indiana CHW State Association and I'm on the board of the Diabetes Leadership Council. I previously served on multiple association boards at the national level, including the Association of Diabetes Care and Education Specialists. I currently work at a federally qualified health center and serve primarily Spanish speaking populations and in multiple areas of my job. work with CHWs. I also employ a CHW. We work with CHWs across food banks, homeless shelters, and a number of different clinic spaces. And so I have in a number of different capacities work with CHWs.
Angela Forfia
All right, thank you so much, Jasmine.
Honey Yang Estrada
Thank you so much for having me. Angela, thank you so much for that warm welcome. My name is Honey Yang Estrada and I'm a long-time community health worker and president of the North Carolina Community Health Worker Association where it is all things CHWs all the time. I'm really excited because at the North Carolina Community Health Worker Association, I get to lead teams regarding advocacy, credentialing, training, and sustainability for all things community health workers across our state. Also very privileged to serve on the board for the National Association of Community Health Workers and also on the leadership team for American Public Health Association. I have worked primarily in healthcare and public health for 20 plus years. So thank you. We're very excited to be here.
Angela Forfia
Wonderful. Thank you so much. I'm so honored to be here with you. I often describe myself as an FQHC groupie. I'm a big fan of the federally qualified health centers and I've spent my career working alongside community health workers. So, I just can't wait to hear what you have to say about CHWs and what they bring to the work that we do in diabetes care. To get us started, can you give us a high level summary of who community health workers are, you what do they do, what are their superpowers?
Honey Yang Estrada
I love this question, Angela. As defined by the American Public Health Association, community health workers are frontline public health workers who have unique relationships with communities they serve. So, using myself as an example, I am a long American woman. I look like the community I serve. I eat the same food. I speak the same language. We practice the same faith.
And so, when we're thinking about diabetes and social determinants of health, these trusting relationships go far beyond the four walls of a traditional clinic setting. And when we're thinking about those superpowers, that lived experience that is so critical in community health worker work, that really helps to build trust. And when we're thinking about trying to achieve all of the outcomes that we want to see happen. This is where the magic happens.
Jasmine Gonzalvo
Yeah, and just to echo a lot of what Honey said, you know, from the clinician perspective, CHWs are everything. The work of CHWs are everything. I've spent so much of my career trying to figure out how people got where they are in terms of health outcomes. How did we get to an A1C of 12, right? How many things had to break down for someone to get to a point where we're really preventing complications, where we could have done a lot of prevention work up front? CHWs are really such a beautiful bridge to a gap that we haven't been able to fill as healthcare providers and as health systems. And the work of CHWs is really critical to getting better care outcomes, mitigating health disparities. CHWs have the reputation, the rapport, the expertise, the lived experience from their own communities, just like Honey was saying, that we don't and can't have as clinicians. So, it's really that lived experience and their ability to connect and shared experiences that really is the missing piece that CHWs hold.
Angela Forfia
You know, sometimes when I'm discussing community health workers out there in the real world, as I talk to people and I talk to nurses or dieticians or pharmacists, I hear things like, well, we just don't have those in my hospital. We don't have community health workers in my health system. So how can you bring the magic? How can you find those community health workers? Are there resources where a hospital can find professionals that specialize in this work?
Honey Yang Estrada
Ooh, Angela, I'm all over this one. You know, from my perspective, it's not that we don't know where they are. It's that we haven't found them yet, right? We haven't identified who they are yet. And they're doing this work. They just don't have the title. So, when we're thinking about recruitment and retention for CHWs, I really want to challenge us to think about stepping outside of how we traditionally do business, right? We can't just post a job on Indeed and expect a community health worker to walk up in here and answer the call. We have to think about engagement from a different perspective.
So, if we're looking for specific communities in need, hang in there and listen up, okay? Because I wanna share a story here. When I worked at a local health department, I was bringing on CHWs. When we were recruiting, I went out to places like flea markets and the laundromat where people congregate that the end does. And we hung out and watched to see if there was someone who took the lead, a point person that community members were often going to. So, you see it's different, right? It's not that we're just posting a job in Indeed and expecting them to answer that ad. We're going out and looking for them in very unconventional spaces. We'd have a conversation with these individuals and come to find out this point person that people kept going to, they were CHWs. They were answering the call. And so, I really want to challenge us to think about how we do this work and to do it differently. When we talk about engagement within the communities, it's not built off of a hiring platform like Indeed and I know I'm picking on Indeed but
Angela Forfia
They're not a sponsor for this podcast, so we're okay, I think.
Honey Yant Estrada
It's not that traditional going out and getting an employee through a hiring platform. It's not just posting your job on your website. It is being intentional, going to those communities. Maybe we have a conversation with them. Maybe we have to start with who do we know from those communities that we can have a chat with and then think about bringing in people who are those leaders that have the trust of those communities and bringing them in into partnership.
Angela Forfia
I love that. Sometimes we need to get outside of our comfort zone and, you know, emerge from behind the walls of our hospital or our public health department and, you know, go to that flea market, go to that cultural festival, you know, really be in community and, you know, be observant of what's going on. Jasmine, do you have any thoughts to share here with, you know, finding community health workers?
Jasmin Gonzalvo
Yeah, just briefly, think there are often times when it's not going to be a surprise that you hear a health system might operate in more of a silo, right? And thinking, we have to stand up our own CHW workforce and we have to figure out the funding. We gotta get a grant. We gotta do this all by ourselves. When there are community-based organizations who do this really well and who it's their bread and butter and they're really good at it. They have a good support network for a team of CHWs and all the health system really has to do is potentially partner with that community-based organization and set up some sort of contracted service for those CHWs who have been doing what they're doing to keep doing what they're doing and just expand it or formalize a strategy or a partnership or a contract with the health system to take care of ex-beneficiaries or their community. So, I think that it's also not always having to reinvent the wheel when there are community-based organizations who you could easily partner with that would do a fantastic job and could benefit from the resources of partnering with the health system.
Angela Forfia
Yeah, and you know, so valuable for sustainability, for sustaining the support of community health workers and those organizations of community health workers within your communities. So once you have identified, you've tracked down some community health workers, you've brought them into your system, what advice would you give to healthcare organizations so that they're fully integrating community health workers into their interprofessional care teams.
Jasmine Gonzalvo
I think healthcare organizations and clinical providers, firstly and most importantly, need to listen to the community health workers on their team. CHWs have the context and the availability that we may not always have to be connecting to our communities and our populations. for example, I was seeing this client with a high A1C who was doing everything right, reporting everything that I would have thought that they should be doing, right? But we couldn't figure out why his levels were still high. So, I brought in our CHW, kind of told her what was going on just to see if the CHW could kind of figure out that missing piece. And she found several barriers that were standing in the way of his care, improving that I never, I never would have found out on my own. She went into the home and really discovered, right, like medication organization was a mess. And so, I helped organize the medications and, and just simple things like that, that again, kind of being connected to the community and being connected to the client in that important way was something that I as the clinician just couldn't have done.
So, I guess what I'm trying to say here is listen to CHWs first. Organizations have their own priorities, and they can hire CHWs to target some of those priorities. But the next step after identifying the outcomes to improve care is to listen to the CHWs to see what the strategies or most impactful approaches can be, and CHWs can give a voice to something that likely has been missing for a long time.
Angela Forfia
Yeah, I sometimes joke about like wanting to put posters in doctors’ offices or healthcare professionals’ offices. So, I think this would be one that I'll add to my set of posters of listen to community health workers first, that to have that within clinicians offices as they begin that work to open up space for those community health worker voices and bringing them to the table as a full participant within these teams. So, thanks so much, Jasmine. I'm gonna pass this one over to Honey. Thinking about these organizations that have ongoing strategies that community health workers can support, I know that there's a potential misstep here of identifying problems and coming up with a strategy and then, yeah, let's tack on a community health worker at the very end of this. So how do you address that challenge and as I was saying to Jasmine, really fully integrate community health workers into your work?
Honey Yang Estrada
I really want to underscore what Jasmine said. We need to be listening to CHWs first. A big part of this is capacity building. I know in my practice, there is a common theme that when we ask community health workers what they need, their minds automatically go to what their communities need. And this really reflects the heart of the work, right? It reflects the heart of CHWs because they're not necessarily thinking about what they need as professionals. They're thinking about what their communities need and what those gaps are. So, when we're bringing CHWs to the table, we need to be prepared and help them to be prepared to sit at that table, to have conversations about what these needs are and what they look like. Because what you're describing, Angela, is CHWs being tokenized and tokenization leads to harm. And so not only are we harming CHWs, but we're harming the very communities that we aim to seek out to support. This is very, very sticky. It can be very dangerous. And so really thinking about how we support CHWs as professionals and then supporting those CHWs to support their communities.
Angela Forfia
Great, thank you so much. I think that this question kind of continues some of what we've been discussing. One challenge that we hear, you know, both in public health and from diabetes care and education specialists, especially those who are working with and within hospitals and health centers, is a lack of trust or maybe full understanding of community health workers because they are quote unquote not clinical. So how do you help to build that understanding and trust between clinicians like doctors and nurses and diabetes care and education specialists and community health workers to ensure that there's mutual respect and understanding and successful collaboration?
Jasmine Gonzalvo
Number one, hands down, psychological safety. The best way to promote this is through mutual respect, accountability, and trust. Any power dynamics that get in the way or that interrupt this need to be addressed really to integrate a CHW into the team well. And to also remember that we're not competing, we are collaborating. And there's no shortage of people living with diabetes, living with complications. The more programs and professionals, the more access and better care we can provide. And CHWs are definitely appropriate, qualified, and ready to serve these communities. So, psychological safety is where we have to start.
Angela Forfia
Yeah, I often say that we have 98 million people with pre-diabetes. You I often work on the prevention side. And, you know, it's not going to take a village. It's going to take a society to do this work. So, there's no shortage of work for us all to do. And all of our superpowers are needed to make this happen. So, I know there are some new billing codes related to some of this work. I know that sometimes we're so focused on the impact that what we do that we sometimes forget about the funding that needs to support it. So, what are some of those codes that our listeners should be aware of? And do we know that these new codes are going to be beneficial, that they're going to continue our society's investment in community health workers?
Honey Yang Estrada
Oh man, know, billing is so complicated, Angela. And I know that there's a lot of questions around the new billing codes. There's a lot of questions from the CHW community. There's a lot of questions I know here in North Carolina from the partners that I work with. And what I can say here is that I think at this point, there's more questions than there are answers. There's lots of people trying to figure this out. What I will say is in your state, you absolutely should be reaching out and talking with your CHW association or network because every state is so different and at a different point in their CHW journey. In some states, the CHW association does the training and in other states, the state itself is the one that provides the training. So, there's no one size fits all model. What we know is that the CHW associations are absolutely vital and they are the subject matter experts in your stays. And so, when we're assessing the readiness of CHWs and system partners to adopt these codes and how to work with them, there absolutely should be a relationship with the CHW associations in this work.
Angela Forfia
Thank you. Jasmine, please tell me that you have some simple cheat code for me on these billing codes.
Jasmin Gonzalvo
Yep, Angela, you're right. It's super easy. Everybody's doing it. Just give me a call and that's all you need. I'll just tell you how to do it. Three simple steps. We joke, Angela, because obviously it's super complicated. And number one step I would say is check if your state has Medicaid reimbursement opportunities. That's a really sort of low-hanging fruit doesn't exist in my state, right? And we also know that there are Medicare billing codes as well. And so, you really wanna examine your population, who you're serving. Is it largely Medicaid beneficiaries? Is it largely Medicare beneficiaries? To really understand if and how those reimbursement opportunities would be lucrative to your organization. So that is a good starting point.
And then from there, it gets a little messier, as you can imagine, right? And what I would say in working with both health systems and community-based organizations who have stood up both Medicaid and Medicare billing is that it's not pretty. You know, how some people say it's like making the sausage, right? You don't want to watch. You don't want to watch how it's being made, but you'll just eat the delicious sausage later, right? And so that's sort of what's happening in the reimbursement space for CHW codes. And I think you really have to, as an organization, commit to the journey and to the process. I have seen health systems give up because it's messy and because it's complicated, but it really can be lucrative.
And like I mentioned earlier in the podcast, it's also partnering with community-based organizations who are already doing it well. So, it is possible and I think it's becoming more common and we hope also as well less complicated. But at the moment, what I will say just broad strokes is that it is pretty complex and it is a process and a commitment that the organization really has to be ready for and likely consult with some experts to get it across the finish line.
Angela Forfia
So, we shouldn't give up, but like Honey mentioned, we should connect with some partners in our state that can be with us on this journey.
Jasmine Gonzalvo
Absolutely. Connect with experts and partners. Yes.
Angela Forfia
All right. Well, we’ve covered a lot of ground today on how community health workers can improve diabetes prevention, management, and care through a team-based approach. Before we wrap up, I'd love to hear from each of you. What is one key takeaway or piece of advice you'd give to health care teams looking to better integrate CHWs into their huddle?
Honey Yang Estrada
Goodness gracious, Angela. Thank you so much for asking this. I really want to challenge us to think about all the positions that we're in and the power that we hold. So much of this work is centered around power dynamics, how we show up, where we sit, our spheres of influence, and conversations surrounding community health workers have a lot to do with policies that have been created by humans. So, as we work together to move all of these initiatives forward, I really want to challenge each and every one of us to think about the power we all hold in our relationship too. Are we really shifting power to communities or are we merely checking a box? And if we're just doing this work to check a box, then that's performative and we're not actually shifting power to get the results that we really want to see.
Jasmine Gonzalvo
Just snaps, snaps, snaps, snaps, snaps to everything that Honey said. Are we checking a box or are we changing systemic structures? And why are you in the work? I think are really critical questions to ask yourselves as an organization before moving forward. Those involved in this work need to be ready and willing to do the work in the right way to support the CHWs, to support communities in the right way. So, I think you just got to be ready and committed.
Angela Forfia
Thank you for listening to this episode of The Huddle. Remember, being an ADCES member gets you access to many resources, education, and networking opportunities. Learn about the many benefits of ADCES membership at adces.org slash join. The information in this podcast is for informational purposes only and may not be appropriate or applicable for your individual circumstances. This podcast does not provide medical or professional advice and is not a substitute for consultation with a healthcare professional. Please consult your healthcare professional for any medical question.