Community Health Worker Strategy Meeting - IPHA Health... · Community Health Worker Strategy...

Community Health Worker Strategy Meeting

March 20, 2019 Herrin Hospital

Heritage Building

A Value Driven Solution for Population Health

Funding for this Project is Provided by IDPH 1815 Grant; Prevention and Management of Diabetes, Heart Disease, and Stroke

What is a CHW- APHA? “A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of

and/or has an unusually close understanding of the community served. This trusting relationship enables

the CHW 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.

A CHW also builds 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.”

Other Names Promotores de Salud

Community Health Representatives

Community Health Advisors

Peer Navigator

Other

Recommendations Roles and Responsibilities

Training and Certification

Financing & Reimbursement

Workforce Development

Raising Awareness

A National Lens: National Association of Community

Health Workers (NACHW)

Wandy D. Hernandez

NACHW Board Co-Chairs Wandy Hernandez & Sergio Matos

Founding Board of Directors

• 20 Directors • Bi-weekly phone calls since 2016

• In-person meetings across country

• Local/regional representation of USA

• Majority CHW

• Majority women

• Includes both allies and practitioners

• 1 part-time support staff

NACHW Board Members

• Mae-Gilene Begay, mgbegay@yahoo.com

• Naomi Cottoms, ncottoms@aol.com

• Ramona Dillard, RDillard@lagunapueblo-nsn.gov

• Durrell Fox, dfoxnehec@aol.com

• Catherine Haywood, chaywoo@tulane.edu

• Gail Hirsch, gail.hirsch@state.ma.us

• Lisa Renee Holderby-Fox, holderbylr@gmail.com

• Maria Lemus, maria@visionycompromiso.org

• Susan Mayfield-Johnson, susan.johnson@usm.edu

• Anita McDonnell, anita.mcdonnell@outlook.com

• Floribella Redondo, Flor.alasdefe@gmail.com

• Alise Sanchez, alise@orchwa.org

• Julie Smithwick, julie@scpasos.org

• Napualani Spock, nspock@yahoo.com

• Ashley Wennerstrom, awenners@tulane.edu

• Geoff Wilkinson, gww@bu.edu

• Katie Sutkowi, katherinesutkowi@gmail.com, ex-oficio/consultant

Wandy Hernandez, Co-Chair wandyhdz@healthconnectone.org Carl Rush, Treasurer carl@chrllc.net

Sergio Matos, Co-chair sergio@chwnetwork.org Joelisa Castillo, Secretary visionhealthcommunityLLC@gmail.com

Why Now?

• Increased interest in CHWs • ACA • DOL • CMMI • Health Reform Innovations – goals and financing

• Value-based payment, shared risk, bundled payments

• Large body of evidence – effectiveness of CHWs • Business Case

• Value-added, cost-savings, return-on-investment • Outreach, engagement, activation, adherence, retention • CMMI report

• Scholarly texts

• Preserve integrity of CHW work

Honoring Our Past, Building Our Future

NACHW AACHW,

2007 - 2009 APHA

• CHW SPIG, 2000

• CHW Section, 2009

• Resolutions

Unity conferences,

1999 - present

NACHW Mission, Vision, Values

Vision: Community Health Workers united nationally to support communities in achieving health, equity and social justice

Mission: To unify the voices of Community Health Workers and strengthen the profession’s capacity to promote healthy communities

Values: • Self-empowerment of CHWs and their communities • Social justice and Equity • Integrity of CHW work • Dignity and Respect • Unity • Informed Self-determination

Work in Progress

• Non-profit incorporation- Completed Feb. 2019

• Member recruitment & engagement

• Fundraising

• Launch Planning

NACHW’s Value for the CHW Workforce

• Build a unified professional identity

• Preserve workforce integrity

• CHW policy development and advocacy

• Technical assistance to state CHW associations

• National information clearinghouse

• Convene conferences and foster professional collaboration

• Training, networking, and other member services and benefits

• Conduct and disseminate research

Washington, DC, 2018

Membership • Four categories of membership:

• Individual CHW

• Individual Ally (Non-CHW)

• CHW Network Organization

• Other Organization

• Sponsor and Champion memberships core to financial sustainability

• Multiple membership benefits

Make NACHW Your Organization!

Participate in a NACHW Launch Committee

Engage with your local or state CHW organization • Strong local efforts are essential for sustaining a national effort

Make plans to join as a founding member

Attend the Launch at Unity 2019 in April (Las Vegas)

Share information about NACHW with your CHW colleagues

Sign up for NACHW’s mailing list

Join Us for the Official Launch!

Unity Conference, 2019

April 14-17, 2019

Las Vegas, Nevada

All CHWs and allies interested in celebrating

the launch of NACHW are invited and encouraged to attend this historic event!

Thank You

Email: info@nachw.org Website: www.nachw.org

Wandy Hernandez

Co-Chair NACHW/Vice President

ILCHWA

wandyhdz@outlook.com

Illinois Department of Public Health Community Health Worker (CHW) Update

Paula Jimenez, RN

Mona Van Kanegan, DDS, MS, MPH

Centers for Disease Control Grant Period (October 1, 2018 – June 30, 2023)

DP18-1815 Improving the Health of Illinoisans Through Chronic Disease Prevention

Long Term Outcomes

• Decreased proportion of people with diabetes with an

AIC>9

• Increased number of people with prediabetes enrolled

in a CDC-recognized lifestyle change

program who have achieved 5-7% weight loss

• Increased control among adults with known high

blood pressure and high blood cholesterol

DP18-1815 Improving the Health of Illinoisans Through Chronic Disease Prevention

2 Out of 10 Strategies involve CHWs

• Develop a statewide infrastructure to

promote long-term

sustainability/reimbursement for

CHWs as a means to establish or

expand their use in

– a) CDC-recognized lifestyle

change programs for type 2

diabetes prevention and/or

– b) ADA-recognized/AADE-

accredited DSMES programs

for diabetes management.

Strategy A7

• Develop a statewide

infrastructure to promote

sustainability for CHWs to

promote management of

hypertension and high

blood cholesterol.

Strategy B5

ADA – American Diabetes Association

AADE – American Association of Diabetes Educators

DSMES – Diabetes Self-Management Education and Support

DP18-1815 Improving the Health of Illinoisans Through Chronic Disease Prevention

Asthma Education and

Environmental Management

• Asthma education/environmental management are evidence-based

strategies that reduce asthma-related emergency room visits and

hospitalizations and reduce health care costs.

– reimbursement tends to be lower

• GOAL: To expand access to evidence-based, home-based asthma

education and environmental interventions through sustainable financing

mechanisms.

– Expand reimbursement for asthma educators, CHWs.

– Amend contracts between state Medicaid and Medicaid

Managed Care Organizations to enable and provide guidance for

the use of CHWs.

EH-14-1404 Comprehensive Asthma Control Through Evidence-Based Strategies and Public Health – Health Care Collaboration

Health Resource and Services Administration (September 1, 2018 – August 31, 2022)

HRSA-18-014 Grants to States to Support Oral Health Workforce Activities

Project Approach

Improve understanding of oral health workforce, workforce

shortages and capacities in Illinois to better focus on improving

oral health status of Illinoisans,

Implement workforce strategies in selected areas of state (see

next few slides)

Use project outcomes and evaluation of IOHWA to re-align key

tasks, if needed.

HRSA-18-014 Illinois Oral Health Workforce Activities

IOHWA - Illinois Oral Health Workforce Activities

County/are

a

Population

Characteristics

% of

childre

n

FRLP**

ED visit

rates*

Workforc

e Focus

Area

Cook/Will Large urban area with

pockets of rural,

population: 6M

40-

68%

16.2-

56.3

CHW,

CDHC

LaSalle/Put

nam/Burea

u

Rural, Population: 150K,

40% of population

without dental insurance

35-

53%

56.4-

169.8

CDHC,

PHDH

Knox/Warr

en/Fulton

Rural, Population: 104K,

45% of population

without dental insurance

55-

66%

56.4-

169.8

CHW,

PHDH

Champaign Rural area with pockets of

urban, Population: 31%

of population without

dental insurance 208K

54%

110.3-

169.8

CHW,

PHDH

Christian Rural area with pockets of

urban, Population: 33K,

38% of population

without dental insurance

56%

169.9-

228.9

CHW,

PHDH

Jackson Rural area with pockets of

urban, Population: 59K,

35% of population

without dental insurance

66%

110.3-

169.8

CDHC,

PHDH

HRSA-18-014 Illinois Oral Health Workforce Activities

Long Term Workforce

Objectives Utilize a layered approach that increases the number of skilled

providers of oral health care in Dental HPSAs and improve the health

status of community members living in targeted Dental HPSAs by

expanding roles and numbers of the three community health-related

professionals, CHW, CDHC and PHDH

1) Expand the role of CHW by including oral disease, oral health and

pain management in their training curriculum,

2) Utilize CDHC curriculum component (i.e., internship) to provide

education and prevention services to underserved children, and

3) Leverage the newly legislated PHDH to increase the accessibility to

clinical services in public health settings (schools, FQHCs, and LHDs)

HRSA-18-014 Illinois Oral Health Workforce Activities

CHW - Community Health Worker

CDHC - Community Dental Health Coordinator

PHDH - Public Health Dental Hygienist

HPSA - Health Provider Shortage Areas

Strategies that Involve CHWs

Discussion with Illinois stakeholders demonstrate a willingness to review and expand CHW Curriculum.

(oral health and disease concepts including navigation and dental pain management)

• Systemic, sustainable solutions led by CHW leaders

• Close the gap in oral health knowledge and begin to re-integrate oral health as a mainstream health issue

• Focus on individual behavior change, prevention, navigation to treatment and their impact on chronic health conditions

HRSA-18-014 Illinois Oral Health Workforce Activities

Measureable CHW

Objectives

1) Include oral health training in state-certified CHW curriculum

2) By August 31, 2022, implement newly certified CHW curriculum in

at least 3 college/universities in the state

3) By August 31, 2022, complete training of at least 50 CHW students

that can work in HPSAs.

HRSA-18-014 Illinois Oral Health Workforce Activities

CHW - Community Health Worker

HPSA - Health Provider Shortage Area

Illinois Department of

Public Health

Paula Jimenez, RN

Assistant Chief, Division of Chronic Disease

Paula.Jimenez@Illinois.gov

Nikki Woolverton, MPH

Asthma Program Manager, Division of

Chronic Disease

Nikki.Woolverton@Illinois.gov

Mona Van Kanegan, DDS, MS, MPH

Chief, Division of Oral Health

Mona.VanKanegan@illinois.gov

Thank You! Questions?

Implementing and Integrating CHWs in Central and Southern Illinois

Tracey Smith, DNP, PHCNS-BC, MS

March 20, 2019

Community Health Worker Strategy Meeting

Herrin, Il

From the Farm I learned the three “L”s of life

What are the three “L” s of life?

• Listening • taking notice of and acting on what someone says

• Loving • feeling or showing love or great care- accept me as I am

• Looking • regarding in a specified way

Just Listen To Me

Show Up Don’t Give UP!

Equality vs. Equity

Basic Approach: Philosophies for SIU

Community Health Worker Models

Harm reduction Motivational interviewing

Trauma informed care

Accompaniment

Trust

SIU Community Health Worker Models

• Lay Health Worker Model

• Member of Care Delivery Team Model

• Care Coordinator/Manager Model

• Health Educator Model

• Outreach and Engagement Model

• Community Organizer and Capacity Builder Model

Rural Health Information HUB: https://www.ruralhealthinfo.org/toolkits/community-health-workers

Diabetes

Hypertension

Mental Health

Pediatric Asthma

Enos Park Neighborhood: A Community Organizer and Capacity Builder Model

43

Even Disadvantaged Neighborhoods Are

Not the Same

“There are places and cities around the country that are very

poor, but still benefit from community gardens, and active

religious organizations, nice parks – and the people who live in

those places are likely to be healthier, live longer life

expectancy, and better capacity to survive crises like

hurricanes or heat waves than are people who live in

comparably poor neighborhoods but who don’t have that

social infrastructure to support them.”

Klinenberg, E. (Guest) & Ben-Achour, S. (Host). (2018, September 11). How "social infrastructure" can save us all [Radio Broadcast Episode]. https://www.marketplace.org/2018/09/11/sustainability/social-infrastructure-helps-keeps-us-safe

Outcomes of Enos Park PRogram

● Increased:

○ Employment by 50%

○ Income by 200%

○ Food and nutrition by 50%

○ Health care coverage by 50%

○ Life skills by 40%

○ Mobility by 100%

○ Community Involvement by 66.7%

○ Physical Health by 25% *

○ Increased Asthma action plans and high blood pressure control

● Decreased:

○ Police Calls by 44%

○ No Shows to Medical Appointment by over 60%

○ Unnecessary Emergency Room Visits by over 25%

○ Evictions from housing by 80%

○ Recidivism rate by 54%

○ HgA1Cs

○ Decreased Asthma ED Visits, Smoking Rates

Engagement of Patients Working With a CHW in Enos

A Medical Home was created for 100% of

our clients

Engagement with primary care providers

was high

96% of our patients saw a primary care

provider at least once in the past year

No children in program excluded from

school

Our patients had an 83% show rate up

from a 17% show rate!

Expansion of CHW Concept….

• Brandon Court

• East Springfield Program

• Access to Health Program: Enos and Pillsbury

• Healthy Jacksonville

• Quincy Public School Health Collaborative

• Helping Hands Shelter

• Mercy Communities

• Sangamon Court System

Total CHWs trained: 20 CHWs, 5 CHW Supervisors, 15 CHWs special training in diabetes, asthma, complex care, ED overuse with an emphasis on the life spectrum

Financial Outcomes – An Example

Month

Inpatient/ Emergency

Visits Total Charges Actual

Payment True Cost

30 days between

Visits?

Preintervention

January 1 $ 48,422.84 $ 9,921.38

$ 16,337.24

February 0 $ - $ - $ -

March 1 $ 51,061.70 $ 11,211.06

$ 24,955.46 Yes

April 3 $ 84,998.58 $ 20,025.92

$ 28,877.56 No

May 1 $ 37,736.30 $ 6,993.62

$ 19,805.53 No

June 1 $ 28,266.40 $ 2,743.28

$ 14,195.98 No

July 1 $ 98,259.54 $ 6,450.29

$ 42,451.44 Yes

Totals Preintervention

8

$ 348,745.36

$ 57,345.55

$ 146,623.21

Average Preintervention

1.14 /Month

$ 49,820.77

$ 8,192.22

$ 20,946.17

Intervention

August 2

37,376.29 2,747.72 $ 17,517.15 No

September - December 0 $ - $ - $ - N/A

Totals Post-intervention

37,376.29 2,747.72 17,517.15

Avg. Post-intervention

7,475.26 549.54 3,503.43

Average 30 Days Post $ - $ - $ -

2

0.4 /Month

0 /Month

Program has exceeded our expectations.

American Hospital Association 2018 NOVA Award for collaboration on looking beyond physical ailments to address economic and social barriers to care.

SIU CHW Training Program ETC…(Evolving Training for Community Health Workers)

• Combination of trainings for the continuum of CHW provision including:

• Consulting Model for implementation, administration, and evaluation of CHW programs

• Specific training programs for CHWs to function in the different CHW models and directions including disease specific, complex care, chronic care, substance use, and super utilization of resources

• Mixture of learning modalities utilized including in person, technical assistant calls, and ECHO • ECHO (Extending Community Health Outcomes) is a training model

created at the University of New Mexico which utilizes Zoom technology to connect the ETC… training team at SIU SOM and CHW teams at distant sites through an audio/video platform.

• The model utilizes an all-teach, all-learn model that includes a short

didactic session, a case presentation, discussion, and the development of recommendations.

• *** Broad band issues can be addressed practically.

• Training content aligns with the core skills prioritized by the Illinois CHW Advisory Board

• An SIU Certificate in CHW will be provided to those who complete programming

The ETC…Training Team is an interdisciplinary team made up of:

• Nurse • Masters in Communication, CHES • LCSW/LCPC • CHW • Pharm D

Tracey Smith 217-825-9181 tsmith@siumed.edu

Community Healthy Worker Strategy

Where Do WE Go From Here?

BIG Questions we need to address prior to submission of recommendations

• Who/ What entity will be the Certifying body for CHW in Ill?

• What will be the status of institutions of higher learning who are already implementing a State Certification (approved by Ill State Board of Ed) for CHW (Malcolm X and South Suburban College)?

• Will there be a re-certification process for agencies and CHW’s?

• How do we address reimbursement for CHW given the various level of CHW throughout the State? How do we “guarantee employers” the competency of a CHW?

Next Steps Review and Summarize input from

Today’s Session

CHW Strategic Planning Committee meet to discuss next steps

Based on recommendations from all 3 sessions (Chicago and 2 downstate) the Strategic Planning Committee will develop an addendum to the original CHW 2016 Recommendation Report

Convene one more meeting to discuss certification process etc

Circulate addendum for comments to CHWs and CHW Stakeholders throughout the state.

Convene a final strategy meeting to review final recommendations/addendum

Submit to Final Recommendations to Governor, Fall 2019

Any Burning Questions or

Suggestions that was not listed ?

Questions or Suggestions Please contact

Angela Ellison

aellison@uic.edu

Thank You for Your Time Today!!!

Thank You

• Illinois Department Of Health

• Illinois Public Healthcare Association

• Illinois Community Health Worker Network

• Malcolm X College

• Sinai Urban Health Institute

• University of Illinois – Chicago

• Southern Illinois University

• South Suburban College

• Chicago Department of Health