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HOME IS THE HUB

An Initiative to Accelerate Progress to toReduce Preventable Readmissions in Virginia

Special Topic Webinar #2:Community Health Workers (CHWs) in Virginia

Wednesday, April 19, 201610:00 a.m. – 11:30 a.m.

HOUSEKEEPING

• Slides were sent this morning• Webinar is being recorded• Please use the “telephone” option

• Audio pin prompt• All participants are muted• Raise your hand • Ask a question

WELCOME AND OVERVIEW

Abraham Segres VHHAVice President, Quality & Patient Safety

asegres@vhha.com (804) 965-1214

VIRGINIA HOSPITAL & HEALTHCARE ASSOCIATION

An association of 30 member health systems representing 107 community, psychiatric, rehabilitation and specialty hospitals throughout Virginia.

VisionThrough the power of collaboration, the association will be the recognized driving force

behind making Virginia the healthiest state in the nation by 2020.

MissionWorking with our members and other stakeholders, the association will transform Virginia’s health care system to achieve top-tier performance in safety, quality, value, service and population health. The association’s leadership is focused on: principled, innovative and effective advocacy; promoting initiatives that improve health care safety, quality, value

and service; and aligning forces among health care and business entities to advance health and economic opportunity for all Virginians.

VHHA 2015-2020 IMPROVEMENT PRIORITIES

1. Reduce preventable hospital readmissions1a. Hospital-wide1b. Post-acute transfers1c. Total hip/Total knee Replacement 30-day readmissions

2. Reduce healthcare-acquired infections (Clostridium difficile)3. Improve the patient’s experience of care – HCAHPS 4. Report and learn from Serious Safety Events

Readmissions Reduction Statewide Learning & Action

June 2016 to November 2018

• Focus on Post-Acute, Multi-Visit Patients (MVPs), and Total Hip/Total Knee Replacement in parallel

• Engage with partners in Post-Acute Settings• Engage with HQI for cross-continuum work• Engage with AAAs for community based care/CTI• Provide, use, interpret data from VHHA & VHQC

Activities for Statewide Learning & Action in 2017

January 25 - Deep Dive Webinar: ED-Based Strategies

February 22 - Special Topic Webinar: Insights from Anthem

March 15 - Office Hours w/ Dr. Boutwell

April 19 - Special Topic Webinar: Community Health Workers

May 17 - Deep Dive Webinar: Hospitals & SNFs Transitions

June 14 - TBD

July 12 - Home is the Hub Playbook Release

August 16 - TBD

October 18 - Statewide In-Person Learning Event

*All webinars are offered at 10am and materials are made available on the VHHA website*

TODAY’S AGENDA

1. Community Health Workers in Virginia: Moving the Agenda Forward

2. Case Study #1: Sentara Rockingham Memorial Hospital (RMH)

3. Case Study #1: VCU Health

4. Questions

Community Health Workers (CHWs) in Healthcare Delivery Transformation:

Messages and Thoughts From

Amy Boutwell, MD, MPPCollaborative Healthcare Strategies

CHWs in Healthcare Delivery Transformation

• Hospitals are responding to market pressures to transform delivery of care:• Higher quality, lower cost, better experience

• Healthcare delivery transformation requires us to develop better systems to:• Manage care across settings and over time• Address medical, behavioral, and social needs without artificial boundaries

• Community Health Workers help accomplish these goals:• Engage patients: form a trusting, helpful relationship• Navigate: reduce barriers through connection to healthcare teams

• In Massachusetts, there is a 24- hospital, $60M healthcare delivery transformation initiative focusing on reducing hospital use: Among all role-types hired in these 24 teams, #1 hire were CHWs!

• In New York, the $8B Medicaid Delivery System Reform Incentive Program aims to reduce hospital use by 25% In their ED and Hospital High Utilizer Programs, most teams seek to add CHWs

(“navigators”) to augment nurse and social workers’ efforts to coordinate careRecognizing ”helpful, trusting relationship” and “direct navigation support” are

needed to achieve goals of managing care across settings and over time

CHWs in Healthcare Delivery Transformation

• How are CHWs funded in delivery system transformation efforts I see/advise?• Medicaid: DSRIP, DSTI, Health Home• Medicare: ACO, bundle, readmission penalty avoidance teams• Payer-blind: private, state or federally funded demonstrations

• When considering our objectives in Home is the Hub - reduce readmissions to promote quality and also to minimize undesirably high readmission penalties:

• Consider adding CHWs to your internally-funded readmission reduction teams• Particularly relevant for our “high-leverage” focus areas:

• Hospital to Home (as exists in the AAA care transitions coaching efforts)• Post Acute Care (augmenting skilled nursing care, navigation across settings)• Multi-Visit Patients (forming helpful, trusting relationships, direct navigation support)

CHWs in Healthcare Delivery Transformation

COMMUNITY HEALTH WORKERS IN VIRGINIA: MOVING THE AGENDA FORWARD

Institute for Public Health Innovation

Sonya Kibler, MS, MPHProgram Manager, Healthy and

Equitable Communities

Community Health Workers in Virginia: Moving the Agenda Forward

Sonya Kibler, MS, MPHProgram Manager, Healthy and Equitable Communities

April 19, 2017

What is a Community Health Worker?

What is Distinctive About Community Health Workers?

Do not provide clinical care Generally do not hold a professional license Expertise is based on shared life experience (and often culture and

community) with people served Rely on relationships and trust more than on clinical expertise Relate to community members as

peers rather than purely as clientsor patients

Can achieve certain results that other professionals cannot

Acknowledgement: Carl Rush, Community Resources LLC

Why Community Health Workers?Why Now?

Recognition of CHWs as an official job classification by the Department of Labor in 2010

Medicaid rule change opens door for Medicaid financing of CHWs

Trends toward Patient-Centered Medical Homes, Accountable Care Organizations, and value-based financing

Emerging evidence base demonstrating significantReturn on Investment (ROI) – average of about 3:1

Increased recognition of the evidencebase related to improved health outcomes

Virginia CHW Definition

“A Community Health Worker applies his or her unique understanding of the experience, language and culture of the populations he or she serves to promote healthy living and to help people take greater control over their health and their lives. CHWs are trained to work in a variety of community settings, partnering in the delivery of health and human services to carry out one or more of the following roles:-Providing culturally appropriate health education and information- Linking people to the services they need- Providing direct services, including informal counseling & social support- Advocating for individual and community needs, including identification of gaps and existing strengths and actively building individual and community capacity.”

(Interim Report: The Status, Impact, and Utilization of Community Health Workers, James Madison University, 2005)

Models- Clinical vs. Community

1st photo: credit to National Association of Social Workers Michigan Chapter

Virginia’s Structure

Virginia CHW Advisory Group

Virginia CHW Policy and Finance Committee

Virginia CHW Association

CHW Advisory Group

Raise awareness of CHW efforts statewide and addressing topics such as scope of practice, credentialing, reimbursement, professional development, etc.

Meets monthly Priorities:Define CHW scope of practice/finalize core competenciesDevelop model training requirements Recommend a process for credentialing CHWs to ensure that

CHWs have the required skills and knowledge Explore financing options

CHW Advisory Group Membership

American Cancer Society Bon Secours Cancer Action Coalition of VA Capital Area Health Network Chesterfield Health District Crater Health District Crossover Ministry Dept. of Aging DMAS Fan Free Clinic Free Medical Clinic of Northern Shenandoah Valley, Inc. George Mason University Gilpin Ct. Resource Ctr. George Washington University Healthy Roanoke Valley Henrico Health District INOVA IPHI J. Sargeant Reynolds Community College James Madison University

Lord Fairfax Health District Martinsville-Henry County Coalition for Health Mosby Ct. Resource Ctr. Northern Neck Health Coalition Northern VA Community College Prince William Health District Peninsula Health District Portsmouth Health District Richmond City Health District Southern VA Higher Education Ctr. Thomas Jefferson Health District Three Rivers Health District Virginia Beach Health District Virginia Commonwealth University Virginia Community College System Virginia Community Healthcare Assoc. Virginia Dept. of Health Virginia Health Quality Center Virginia Oral Health Coalition United Way of Roanoke Valley University of Virginia

Sub-Committees

Certification & TrainingRequirementsHoursOrganizationGrandfatheringCertifying entity

Policy and Finance PlanningWorks on policy and finance issues

Policy and Legislative Goals

Address state legislative priorities to support workforce development

Raise awareness among and engage legislative partners

Advocate for bills that officially recognize the CHW workforce (especially during Advocacy Day)

CHW Legislation in GA Session (2017)

Support S.B. 1557, a bill directing the Department of Health to establish a work group to examine the risks and benefits of having CHWs in the Commonwealth. The bill directs the work group to:

1. develop a scope of practice and core competencies for community health workers;

2. adopt consensus training and certification standards; and 3. identify a certifying entity, policy priorities to support the

sustainability of CHWs, strategies to increase awareness of the uses and the role of a CHW, and sustainable payment systems for CHW systems as a part of an integrated health care team.

Finance

Solicit feedback from decision-makers regarding opportunities to support the utilization of CHWs

Identify sustainable payment systems for CHWs

One of the key ways that we are doing this is through creation of a Policy and Finance CommitteeMCOsHospital systemsVDHFQHCs

Policy and Finance Committee

Comprised of high-level decision makers with the ability to move the CHW workforce development and financing agenda forward.

Formed November 2016Meet twice/year

Priorities:State legislation that defines and legitimizes CHWsMedicaid reimbursement and alternative/innovative funding

models

Communications Sub-Committee

Audience IdentificationGoals and ObjectivesCommunications ToolsKey Messages and Branding IdentityPlan timeline and evaluation

Strategies and Tools to Reach Goals

Webinar Educational Video PowerPoint Slides/Presentations Website Logo Speaking Engagements Elevator Speech Provide a monthly report to CHW

Association and Advisory Group Email updates

CHW Association

An advocacy, networking and professional development group that is lead by and for CHWs in Virginia.

Meets Monthly

Priorities:Set By-LawsSet leadership, and how they will communicate with the CHW

Advocacy, and Policy and Finance GroupsEstablish scope of practiceDiscuss resources

Accomplishment To-Date

• Core Competencies• Scope of Practice• Joint Commission on Health Care

• August 8, 2016 – presented on CHW efforts• November 2, 2016 – requested Code of VA acknowledge

CHW Advisory Group; letter of support approved• Policy Meeting November 30, 2016 with the next one May

4, 2017• Advocacy Day- January 30, 2017

Sentara RMH Medical Center CHWs and Supporters

Sonya Kibler, MS, MPHProgram Manager, Healthy and Equitable

Communities

skibler@institutephi.orgDirect line: (804) 269- 8323

OPTIMIZING CARE TRANSITIONS THROUGH AN INTEGRATIVE PARTNERSHIP WITH

CONTINUUM CASE MANAGERS & COMMUNITY HEALTH WORKERS

Laura Watson BSN,RN-BC,CHFN,CCCTMContinuum Integrated Care Manager

Sentara RMH Medical Center Harrisonburg, VA

Optimizing Care Transitions through an

Integrative Partnership with Continuum Case Managers & Community Health Workers

Laura Watson BSN, RN-BC, CHFN, CCCTM

Project Objectives

• Quality of Life• Readmissions• ED Visits• Healthcare Costs

Continuum Case Managers• Innovative role focusing on the chronically and/or complex medically ill patient who

has had a lengthy hospital stay, numerous comorbidities, multiple discharge planning needs, or a history or potential for readmissions.

• The case manager meets with patients during their hospital stay, building a relationship with the patient and the family.

• Following patient discharge, they make home visits to review the medication reconciliation process in the home, make certain that discharge instructions are clear to the patient and family, and make sure follow-up physician office appointments have been made and that the patient plans to go.

• Follow-up phone calls and visits are also scheduled with a frequency based on the patient's needs.

Initial CCM Outcomes• Decreased readmissions/ED Visits• Decreased Costs/Financial Opportunities• Determined that much of the nurses’ time was spent doing things that it did

not take a “RN” to do; estimated to be = or > 50%• Unable to serve a larger number of patients due to above factors• Need for more skill appropriate and cost effective chronic care management• Led us to the literature and evidence…

Highlights of Community Health Worker

Literature Review &Evidence Based Practice

CHW Project Design• Grant funding received for 18-month project to support 3 CHW positions• A CHW is paired with each CCM• Patients are identified using the same criteria as currently used for CCM. Patients

are seen by the Continuum Case Manager who assess the patient and determine the level of care needed. If the patient will benefit from CHW services, a plan of care is developed by the CCM with input from the healthcare team.

• If CHW services are deemed appropriate by the CCM, this service is described and permission/consent is obtained

• Ongoing communication occurs with all members of the interprofessional healthcare team members

Setting/Study Population

• Sentara RMH Medical Center

• Community setting though the current continuum case management model

• Incorporation of the CHW into the patient’s plan of care

Roles of the CHW• Health education• Healthcare system navigation • Arranging transportation to/from healthcare appointments• Collecting vital signs, weights• Reviewing home

environment for potential safety concerns

• Assistance with financial associated paperwork, forms

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Patient/Family

Continuum Case

Manager

PCMH Care

Coordinator

Other Team Members

Physician(s)

Social Workers

Community Partnerships

CHW:Integral Member of the Post-Discharge Team Community

Health Workers

HH/Hospice

Pharmacists

Therapists

Educators

Tools/Sources of DataResources• Use of plan of care to determine appropriate

skill mix (RN/CHW)Education• Minnesota Living with Heart Failure

Questionnaire (MLWHFQ©)Designed to measure the effects of the disease process and treatments of heart failure on an individual’s quality of life through 21 questions, 6-point Likert scale (Rector, 2015)• Patient Interaction Tool (patient teaching and

referral documentation)

AccessReadmission and ED Visits• Patient’s electronic health record

(Meditech/Epic)

Healthcare Finances• Patient’s electronic health record (financial

module, Meditech/Epic)

Project Design• On the first visit, CCM and CHW services were described to the patient.

The HF study was also defined. Permission/consent was received at this time.

• The MLWHFQ© was administered by the CHW and the CCM conducted an initial assessment on the first visit.

• A plan of care was developed between the patient, CCM, and CHW based on the CCM assessment and results of the MLWHFQ©.

• CHW services were incorporated into the plan of care over the next 3 months.

• The MLWHFQ© was administered again after 3 months of services.

Data Analysis

N=41 heart failure patients

Study Period: April-September 2016Pre-Data: 3 Months Pre-CHW Interventions

Post Data: 3 Months Post-CHW Interventions

Pre QuestionnaireMean/Std. Deviation

Post QuestionnaireMean/Std. Deviation

Paired T-Test

(t value)

Physical Dimension 26.3(8.2) 8.7(5.1) 13.3*

Emotional Dimension 14.4(5.8) 7.6(4.7) 7.3*

Total Score 59.7(15.8) 22.2(11.2) 15.1*

Table 1: Minnesota Living with Heart Failure Questionnaire (MLWHFQ©)

*Paired t-test p=<.01

Pre Post Paired t-test (t value)

Total Admissions 84 17

Total ED visits 74 18

Mean Admissions (SD)

2.02 (1.1) .47(.65) 7.59*

Mean ED visits (SD) 1.75(1.3) .50 (.77) 5.51*

Table 2: Access--Admissions & ED Visits

Paired t-test *p=<.000

Additional Data AnalysisResources• Most appropriate skill mix was used

based on the individualized plan of care

Education• Education was provided on each visit

and documented in the patient’s record

• 1-6 referrals were made based on findings from the MLWHFQ©

Healthcare Finances• Total charges were compared 3

months pre and post initiation of CHW services. Total charges decreased by $846,225 or 79.2%.

ConclusionsWith an increasing national focus on population health management strategies, Community Health Workers have emerged as important members of the interprofessional health care teams.

CHWs are especially effective at improving health outcomes and overall quality of life for high-risk and underserved patient populations.

As a result of improved quality of life, patients experience decreased readmissions,unnecessary ED visits, and overall healthcare costs.

AcknowledgementsGina Sprouse CHW

Patra H. Reed DNP, RN, CNML, CCCTMDonna S. Hahn DNP, RN, NEA-BC

Linda J. Hulton PhD, RN

Questions?

COMMUNITY HEALTH WORKERS FOR CHRONIC DISEASE MANAGEMENT:

VCU APPROACHWally R. Smith, MD

Florence Neal Smith Cooper Professor of Medicine

Vice-Chair for Research, Division of General Medicine

Shirley Johnson, LSW

Research Operations Manager and Patient Navigator Supervisor, Division of General Medicine

Virginia Commonwealth UniversityRichmond, VA

Wally R. Smith, MDFlorence Neal Smith Cooper Professor of Medicine

Vice-Chair for ResearchDivision of General Internal Medicine

Virginia Commonwealth University

COMMUNITY HEALTH WORKERS FOR CHRONIC DISEASE MANAGEMENT: VCU APPROACH

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WHAT IS A COMMUNITY HEALTH WORKER (CHW)?• A lay person from a given community who works one-on-one with individuals to

improve health outcomes and healthcare system efficiency. • Called many different terms

• Outreach worker

• Health advocate

• Promotora de salud

• Navigators

• Guides

• Peer counselor

• Lay health worker

• Lay health advisor

• Peer health advisor

• Peer leader

• Broader Definition includes non-lay people

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WHAT IS THE VALUE OF CHWS?• Improvements in chronic disease outcomes

• Asthma • Hypertension• Heart disease• Diabetes• HIV

• Improvements in supportive services • Health care self-management • Disease prevention • Pregnancy outcomes

• Shown to decrease utilization

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WHAT IS THE VALUE PROPOSITION OF CHWS?

• Under Value-based payment• CHWs save money under prospective payment, prevent readmissions, and improve

health maintenance and self-care • Under Fee-for-service payment

• CHWs give high-touch care, • CHWs offer human edge to an otherwise hard-edged health care system;• CHWs help patients keep appointments; and• CHWs increase patients’ use of health care infrastructure

57

WHAT IS THE ROLE OF CHWS WITH THE HEALTH CARE TEAM?• Share responsibility for patient education, support and social services with clinic staff • Empower patients to sustain comprehensive disease management

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OVERLAP AND DISTINCTIONS BETWEEN CHWS AND OTHER HEALTH WORKERS

• Home health aide

• medical interventions

• homebound patients

• Social worker

• more training

• not limited to health care settings

• Public health nurse

• Medical interventions

• Population health rather than individuals,

• Prevention rather than chronic disease

• Nurse’s aide

• Medical interventions

• Usually restricted to health care facility

CHW

Social Worker

Nurse’s aides, nurse

Public health nurse

Home health aide

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CHW CORE ROLES1) Cultural mediation 2) Informal counseling and social support 3) Providing culturally appropriate health education 4) Advocating for individual and community needs5) Assuring that people get the services they need6) Building individual and community capacity7) Providing direct services

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RATIONALE FOR CHWS

• Social, behavioral variables are powerful drivers of health• Behavior is shaped and maintained by consequences:

• immediate feedback from both objective sources (such as blood results)

• an individual’s social network (beliefs and traditions of family and friends).

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CHWS: ONE SIZE DOES NOT FIT ALL

• One term: 5 distinct categories • Numbers of workers in each

category unknown Clinical

Non-clinical

Insurance

Other

Peer

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THREE CHW LEVELS OF SERVICE PROVISION63

PEER (LEVEL 1)

NON-CLINICAL(LEVEL 2)

CLINICAL (controversial)(LEVEL 3)

• Shares conditions, demographics, or experiences with targeted population

• Assists with education and advocacy• Maintains long-term relationships • Changes patient behavior• Lacks education/technically skills • Training or professional development

needs • Credibility with clients

• May not share conditions, demographics, or experiences with targeted population

• Minimal credentials or training• Assists with system navigation and

community resource connection• Maintains long-term client relationship• Initial trust and credibility concerns

• Clinical background (nurse)• Assists with system navigation • Gives medical advice and support

treatment plans. • Enhances access to system

resources• Hired by a health system• No specific case load• Weak client retention after a specific

service• Cultural distance from clients System-

focused mission• May have conflicting goals (hospital

vs clients)

PAYMENT FOR THE CHW WORKFORCE

• Currently, most are grant-funded• The Patient Protection and Affordable Care Act of 2010

• Section 5313, Grants to Promote the Community Health Workforce• Amends Part P of Title III of the Public Health Service Act (42 U.S.C. 280g et seq.) to

authorize CDC, in collaboration with the Secretary of Health and Human Services, to award grants to “eligible entities to promote positive health behaviors and outcomes for populations in medically underserved communities through the use of CHWs…”

• CMS: Medicaid• Effective January 2014, final rule (CMS-2334-F)

• Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligible Notices, Fair Hearings and Appeal Process, and Premiums and Cost Sharing, Exchange: Eligibility and Enrollment

• Opens up payment opportunities for preventive services by nonlicensed individuals.

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WHERE ARE CHWS EMPLOYED IN VIRGINIA?

• Area Agencies on Aging• Hospitals• VDH (Resource Mothers, other programs)• Managed Care Organizations under Medicaid, Medicare• Behavioral Health Authorities, Community Service Boards• No Wrong Door

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VCU AND CHWs

66

• VCU Complex Care Clinic• VCU Geriatrics Center for Advanced Health Management• Partnership with Capital Area Agency on Aging

• CHW called health coach• 1 worker, Census of 25 4-week intervention/pt.• Current goal: to reduce readmissions from hospitalist service

• VCU Heart failure program• VCU Sickle Cell Program

VCU SICKLE CELLENHANCING USE OF HYDROXYUREA IN SICKLE CELL DISEASE

USING PATIENT NAVIGATORS

Wally R. Smith, MD Principal Investigator

R18HL112737

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SHIP HU: SPECIFIC AIM 1

Demonstrate the feasibility of a patient navigator-based program to improve the number of adult (age 15 and older) patients with sickle cell disease (SCD) in the Richmond and Tidewater regions of Virginia who are in SCD specialty care.

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SHIP HU: SPECIFIC AIM 2

Demonstrate the effectiveness of a patient navigator-based program to improve hydroxyurea (HU) (re-) initiation and adherence among adult patients with SCD in the Richmond and Tidewater regions of Virginia who are eligible for HU.

69

SHIP HU OUTCOME MEASURES

70

CASE STUDY: REDUCING UNNECESSARY UTILIZATION USING CHW’S (PT. NAVIGATORS)

71

Rising VCU Sickle Cell LOS, No. Discharges

• CHW Interventions– 5 highest utilizers

• One died• One left system• Three received 1.5 yrs of

intervention

72

ILLUSTRATIVE CASE, INTERVENTIONS

73

• Case: Twenty-seven year old male with severe medical issues:

• SCD SS Genotype

• CKD 2 Kidney Disease

• PTSD

• Depression & Anxiety

• Hypertension

• Per Extremities DVT

• Migraines

• Unspecified Cognitive Impairment

Interventions

Intensive Case management Worked with clinical providers

Housing Issues Discovered Severe Mental Health and Cognitive impairment Issues

Issues related to College Programming

Discovered Transportation BarriersPoor ADL Skills

Victim of Domestic Violence & StalkingLack of Family Support

CHW Team Savings*Labels 2015 2016 CHANGE 2015 2016 CHANGE IMPACTABLE SAVINGS

INPATIENT DISCHARGE 82 50 -32 $752,977.43 $426,541.82 ($326,435.61) ($326,435.61)30 DAY READMISSION 58 32 -26 # # #

ED RETURN 3DAY 41 34 -7 # # #ED DISCHARGE 88 85 -3 $75,044.57 $67,640.39 ($7,404.18) ($7,404.18)OUTPATIENT 28 49 21 $6,493.83 $16,810.42 $10,316.59

OUTPT 23HR OBSERVATION 6 8 2 $24,852.27 $31,877.51 $7,025.24LENGTH OF STAY (DAYS) 477 237 -240 # # #OUTPATIENT RECURRING 0 3 3 $0.00 $9,128.34 $9,128.34

OP AMB PROC 0 1 1 $0.00 $6,484.23 $6,484.23TOTALS $859,368.10 $558,482.71 -300,885.39 ($333,839.79)

UTILIZATION COSTS

RANKING CUT-OFF SIZE COSTS ACCRUED -35.01% SavingsHigh Utilizer X>$199,999 7 $2,418,040.76 $1,571,426.68 $846,614.08Med Utilizers $199,999>X>$99,999 16 $2,113,448.44 $1,373,479.43 $739,969.01Total 23 $4,531,489.20 $2,944,906.11 $1,586,583.09

∆% Change (per CMS) = ( 1 year Savings

Untapped potential savings

*CMS Methodology used for analysis of improvement *Data courtesy of Jeremy Utz 74

CHW’S: SUMMARY

• CHWs have well-defined roles with hospitals and health systems, and core roles for patients and patient care

• CHWs can be used in many, flexible ways• CHWs are valuable and attractive regardless of payment system: they either save or

make money• CHWs help fulfull the Triple Aim: improved health, improved satisfaction, and lower

costs

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QUESTIONS

76

• Thank you for your time.

REFERENCES

77

• Institute of Medicine, 2006. Genes, Behavior, and the Social Environment: Moving Beyond the Nature/Nurture Debate.• Byrd WM. Race, biology, and health care: reassessing a relationship. J Health Care Poor Underserved. 1990 Winter;1(3):278-96. Review. PubMed PMID: 2130908.• Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychological Review. 1977;84:191-215. • Centers for Disease Control. A Policy Brief On Community Health Workers :Addressing Chronic Disease through Community Health Workers: A Policy And

Systems-level Approach. Second Edition April 2015 • Rosenthal, et al., 2010; Behforouz et al., 2004; Cooper et al., 2002; Gary et al., 2003; Gibbons & Tyus, 2007; Burns et al., 2014. • *Rosenthal EL, Wiggins N, Brownstein JN, et al. The Final Report of the National Community Health Advisor Study: Weaving the Future. Tucson, AZ: University of

Arizona; 1998. • **Israel BA. Social networks and social support: Implications for natural helper and community level interventions. Health Ed Quarterly. 1985;12(1),65–80. • ***Smedley B, Stith A, Nebon A. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: Institute of Medicine. The National

Academies Press, Washington, DC (2002). Available at http://www.iom.edu/~/media/Files/Report%20Files/2003/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care/DisparitiesAdmin8pg.pdf. Accessed May 8, 2014.

• Hsu LL, Green NS, Donnell Ivy E, Neunert CE, Smaldone A, Johnson S, Castillo S, Castillo A, Thompson T, Hampton K, Strouse JJ, Stewart R, Hughes T, Banks S, Smith-Whitley K, King A, Brown M, Ohene-Frempong K, Smith WR, Martin M. Community Health Workers as Support for Sickle Cell Care. Am J Prev Med. 2016 Jul;51(1 Suppl 1):S87-98. doi: 10.1016/j.amepre.2016.01.016. PubMed PMID: 27320471; PubMed Central PMCID: PMC4918511.

REFERENCES (CONTINUED)

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• Whiteman LN, Gibbons MC, Smith WR, Stewart RW. Top 10 Things You Need to Know to Run Community Health Worker Programs: Lessons Learned in the Field. South Med J. 2016 Sep;109(9):579-82. doi: 10.14423/SMJ.0000000000000504. PubMed PMID:27598368; PubMed Central PMCID: PMC5014228.

• Hsu LL, Green NS, Donnell Ivy E, Neunert CE, Smaldone A, Johnson S, Castillo S, Castillo A, Thompson T, Hampton K, Strouse JJ, Stewart R, Hughes T, Banks S, Smith-Whitley K, King A, Brown M, Ohene-Frempong K, Smith WR, Martin M. Community Health Workers as Support for Sickle Cell Care. Am J Prev Med. 2016 Jul;51(1 Suppl 1):S87-98. doi: 10.1016/j.amepre.2016.01.016. PubMed PMID: 27320471; PubMed Central PMCID: PMC4918511.

• *As of 2013. Centers for Disease Control. A Policy Brief On Community Health Workers :Addressing Chronic Disease through Community Health Workers: A Policy And Systems-level Approach. Second Edition April 2015

• **CDC. A summary of state community health worker laws. Atlanta, GA: CDC; 2013. Available at: www.cdc.gov/dhdsp/pubs/docs/chw_state_ laws.pdf.

• ***Katzen A, Morgan M. A ordable Care Act opportunities for communi- ty health workers: how Medicaid preventive services, Medicaid health homes, and state innovation models are including community health workers. Cambridge, MA: Center for Health Law and Policy Innovation and Harvard Law School; 2014. Available at: www.chlpi.org/wp- content/uploads/2013/12/ACA-Opportunities-for-CHWsFINAL-8-12. pdf.

• ****Goodwin K, Tobler L. Community health workers: Expanding the scope of the health care delivery system. Washington, DC: National Conference of State Legislatures; 2008. Available at: www.ncsl.org/ print/health/chwbrief.pdf.

CHW RESOURCESAVAILABLE AT HTTPS://WWW.RURALHEALTHINFO.ORG/COMMUNITY-HEALTH/COMMUNITY-HEALTH-WORKERS/1/ROLES

Addressing Chronic Disease through Community Health Workers: A Policy and Systems-Level Approach

Report Provides information and resources for integrating CHWs into community-based programs to prevent chronic disease. Includes policy guidance and examples of state legislative action.

Organization(s): Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke PreventionDate: 4/2015

Community Health Advisor Programs Website An issue paper prepared for NRHA on community health advisor programs. Includes information on what community health advisors do and how they are used in the community.

Organization(s): National Rural Health Association Rural Health Policy Board

Community Health Workers/Promotores de Salud: Critical Connections in Communities

Document Highlights pivotal role of Community Health Workers in treating diabetes in communities. The page also links to several studies from the early 2000’s documenting the history and contributions of CHWs in the study of diabetes prevention.

Organization(s): Centers for Disease Control and PreventionDate: 5/2011

Community Health Worker Intervention to Decrease Cervical Cancer Disparities in Hispanic Women

Article A randomized trial of a promotora-led educational intervention demonstrated improved Pap smear screening rates, in addition to increased knowledge about cervical cancer and self-efficacy. The observed association between cervical cancer knowledge and Pap smear receipt underscores the importance of educating vulnerable populations about diseases disproportionately affecting them.

Author(s): O’Brien, M.J., Halbert, C.H., Bixby, R., Pimentel, S., & Shea, J.A.Journal citation: Journal of General Internal Medicine, 25(11):1186-92Date: 2010

The Community Health Worker Model for Care Coordination: A Promising Practice for Frontier Communities

Report Provides an overview of the CHW model and important issues related to policy, regulation, financing, and workforce development. The report provides examples of how CHW models are emerging in six frontier states: Alaska, Montana, Minnesota, New Mexico, Oregon, and Texas.

Organization(s): The National Center for Frontier CommunitiesDate: 8/2012

Community Health Worker Opportunities and the Affordable Care Act (ACA)

Report Provides an overview of the role CHW roles and the CHW roles under the ACA. Organization(s): Health Resources in Action of BostonDate: 5/2013

Community Health Worker Program Website Describes the CHW program in New York state that provides services to women who are at highest risk for poor health outcomes.

Organization(s): New York State Department of Health

Community Health Workers Website A description of how CHWs fit into Partners in Health's model of community-based care. Organization(s): Partners in Health (PIH)

Community Health Workers: Expanding the Scope of the Health Care Delivery System

Issue Brief Provides an overview of community health workers, including: workforce, impact, relevant legislative action and policy considerations.

Organization(s): National Conference of State Legislatures (NCSL)Date: 4/2008

Community Health Workers National Workforce Study Report Describes a comprehensive national study of the community health worker workforce and of the factors that affected its utilization and development in both urban and rural settings.

Organization(s): U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health ProfessionsDate: 3/2007

Grand-Aides Program: Rural Care Delivery Website A description of how Grand-Aides, a specialized community health worker program, carries out its services in a rural care delivery setting.

Organization(s): Partners in Health (PIH

Making Insurance Exchanges Successful: The Role of Community Health Workers

Blog Describes the role of CHWs in providing enrollment assistance for insurance exchanges established under the Affordable Care Act.

Organization(s): The Century FoundationDate: 2013

Making the Connection: The Role of Community Health Workers in Health Homes

Report Provides an overview of the role of CHWs in Health Homes, which are authorized under the Affordable Care Act.

Organization(s): NYS Health FoundationDate: 9/2012

Minnesota Community Health Worker Alliance Website Description of the Minnesota Community Health Worker Alliance. Organization(s): Minnesota Community Health Worker Alliance

Sitting in Different Chairs: Roles of Community Health Workers in the Poder es Salud/ Power for Health Project

Report Presents the CHWs’ points of view regarding the various roles they play in a community-based participatory research (CBPR) project.

Journal citation: Education for Health. 2008; 21(2)Date: 2008

A Summary of the National Community Health Advisor Study Report Provides a summary of the National Community Health Advisor Study, including core roles of CHWs and recommendations. The study was funded by the Annie E. Casey Foundation.

Organization(s): University of ArizonaDate: 1998

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