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Integrating Community
Health Workers (CHWs)
in Your Practice
April 27, 2016
We Want To Hear From You!
Type questions into the Questions Pane at any time
during this presentation
Patient-Centered Primary Care Institute
• Online Modules
• Webinars
• Website
• Learning Collaboratives
• Trainings
• TA Network
Oregon’s PCPCH Model is defined by six core attributes, each with specific standards and measures• Access to Care “Health care team, be there when we need you”• Accountability “Take responsibility for making sure we receive the best
possible health care”• Comprehensive Whole Person Care “Provide or help us get the health care,
information and services we need”• Continuity “Be our partner over time in caring for us”• Coordination and Integration “Help us navigate the health care system to
get the care we need in a safe and timely way” • Person and Family Centered Care “Recognize that we are the most
important part of the care team - and that we are ultimately responsible for our overall health and wellness”
Learn more: http://primarycarehome.oregon.gov
PCPCH Model of Care
Today’s Presenter
Lisa Ladendorff, LCSWNEON Executive Director,
Community Health Worker Trainer
Learning Objectives
• Explore methods to ensure a match between skills, qualifications and the requirements of the job;
• Learn how CHWs will change the practice workflow and interactions with patients;
• Understand how to add CHWs to a team in a way that both maximizes their role and fully supports their needs; and
• Track emerging models for sustainability.
Community Health Worker Definitions
American Public Health Association Definition
“A community health worker is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served.”
– Liaison– Link– Intermediary
American Public Health Association (APHA). (2016). Community Health Workers. Retrieved from the APAH Community Health Workers webpage at: https://www.apha.org/apha-communities/member-sections/community-health-workers
Oregon’s Definition of CHWs(ORS 414.025)
• Has expertise or experience in public health;
• Works in an urban or rural community, either for pay or as a volunteer in association with a local health care system.
• To the extent practicable, shares ethnicity, language, socioeconomic status and life experiences with the residents of the community where the worker serves;
• Provides health education and information that is culturally appropriate to the individuals being served;
Oregon’s Definition of CHWs(ORS 414.025)
• Assists members of the community to improve their health and increases the capacity of the community to meet the health care needs of its residents and achieve wellness;
• Assists community residents in receiving the care they need;
• May give peer counseling and guidance on health behaviors; and
• May provide direct services(e.g. first aid; blood pressure screening)
Traditional Health Worker Resource Links
• Oregon State Registry for Registered Traditional Health Worker Search
• Oregon State Traditional Health Worker Rules and Policies
• State Approved Training Programs
Links also included on our website www.pcpci.org
Comments or Questions?
Type questions into the Questions Pane
Integrating Into Practice
Qualifications Match
There are two types of qualifications to match:
1. Cultural Qualities 2. Personal Qualities
Cultural Quality Match
Organizational Culture
• Communication style
• Writing ability• Schedule and
timing• Style of dress
Community Culture
• Race/Ethnicity • Language • Rural/Urban• Age• Income Level
Poll Question!
Personal Qualities
• Membership in or shared experience with the community in which they work
• Friendly, outgoing, sociable• Internally strong and courageous, with healthy self-esteem• Patient• Open-minded and non-judgmental• Motivated and capable of self-directed work• Caring, compassionate• Honest• Committed and dedicated• Respectful
Personal Qualities
• Open and eager to grow, change and learn• Dependable, responsible, reliable• Flexible and adaptable• Desire to help the community• Persistent• Creative and resourceful• Sense of humor• Supportive (helping) rather than directive (telling what to
do)• Emotionally mature• A model for trying to live a healthy lifestyle
Developing a Job Description
• Should include: – Job summary– Key functions– Minimum
qualifications– Work context
examples
• Sample job descriptions
– http://cciweb.org/career/Community%20Health%20Worker.pdf
– http://explorehealthcareers.org/en/career/157/community_health_worker
Developing a Salary Survey
• National median hourly rate: $15.00 - $17.45
• State median hourly rate:$13.40 - $27.97
• State salary survey link:– http://www.oregon.gov/EMPLOY/Businesses/Pages/default.aspx
– Click on “Look Up Wages & Job Info”
Bureau of Labor Statistics. Occupational Employment and Wages, May 2015: Community Health Workers. Retrieved from United States Department of Labor website at: http://www.bls.gov/oes/current/oes211094.htmPayScale Human Capital. Community Health Worker Salary (United States), 2016. Retrieved from PayScale website at: http://www.payscale.com/research/US/Job=Community_Health_Worker/Hourly_Rate
Changing WorldviewThe 3 Es
• CHWS are excellent additions to a clinical team and promote a focus on health Equity.
• Engagement and relationship are the key mechanisms by which they work.
• They focus on promoting healthby promoting Empowerment.
Worldview Similarities
Clinic Based Care
• Values team based care
• Focused on patient outcomes
• Stress importance of care coordination
CHW Based Care
• Designed to work best as a part of a team
• Goal is to assist patients in meeting goals
• Work to coordinate health and social service resources
Worldview Differences
Clinic Based Care
• Takes place in clinic• 15-20 minute visits• Health Problem
focused• Provider driven
communication• Clear boundaries• Faster paced
CHW Based Care
• Home/Community Based Care
• Hour or longer visits• Barrier and Asset
Focused• Patient driven
communication• Unclear boundaries• Slower paced
Supervision Implementation
• CHWs will need support and professional development after initial training.
• Home based work often gets messy, as it intentionally erases some boundaries, so CHWs will need support in boundary determination and setting.
• CHW will often face challenges of engagement and relationship, things of a less medical nature
Poll Question!
Infrastructure Checklist
a home visiting policy that includes home visiting safety protocols.
cell phones enabled with textat least basic laptops with the ability to connect via
wireless or hot spot in patient homessupport for mileage reimbursementsupervisors who have some training in and
understanding of CHW history and roles, as well current functions and challenges
dedicated supervision time that is long enough to allow for reflective learning
to be connected to other peer CHWs
Sustainability
CHW Reimbursement
Fee for Service
• Direct CCO payments (e.g.: EOCCO billing policy)
Value Based
• NEON Pathways Community Hub
• Transformation Grants
• FQHC/Migrant Health Centers
Indirect Reimbursement
Fee for Service
• Twinned with RN Care Manager
Value Based
• Patient Centered Primary Care Home Value Added PMPM
• Medicare Chronic Care Management
Models for Sustainability (ROI)
SUMMARY ROI FIND OUT MORE
Molina Healthcare of New Mexico (MedicaidManaged Care)
Uses CHWs to intervene with plan’s highest resource-consuming patients, including those with high ED usage and low treatment adherence
Approximately $4 of savings for every $1 of cost.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343233/
Denver Health Community Voices outreach program works with underserved populations on issues including appropriate outpatient service utilization.
$2.28 savings for every $1.00 invested in the program.
http://communityvoices.org/assets/wp-content/uploads/2014/02/ROI-of-Community-Health-Workers.pdf
CHRISTUS Community Health Care
Management for the Uninsured Quality Management Committee Annual Report
Average annual cost for care among program participants decreased by $10,000 or 58%.Over a three year period, the ROI was 3.84:1
http://www.christushealth.org/CHRISTUSHealthCommunityDedication
Georgia A self-insured manufacturer in Georgia and a labor union in Atlantic City use CHWs to coordinate care and self-management for employees with the highest health care costs.
returns as high as 4.8:1
Next Steps
• If you haven’t thought about CHWs in your practice yet…
• If you know you want to incorporate CHWs…
• If you already have one but are not sure how to best utilize them…
CHW Analysis Tool:Community Assessment
CHW Analysis Tool:Workload
CHW Analysis Tool:Budget
CHW Analysis Tool:Revenue
What Questions Do You Have?
Type questions into the Questions Pane
Thank you!
Please send any further questions to: [email protected]
Resources:• Oregon State Registry for Registered Traditional Health
Worker Search• Oregon State Traditional Health Worker Rules and Policies• State Approved Training Programs
Additional Resources
Rural Assistance Center The CHW Toolkit is made up of several modules concentrating on different aspect of CHW programs
https://www.raconline.org/communityhealth/chw
US Dept of Health and Human Services Health resource and Service Admin (HRSA), Office of Rural Health Policy (ORHP)
The CHWs Evidenced Based Models toolkit includes several successful strategies with rural communities.
https://www.hrsa.gov/ruralhealth/pdf/chwtoolkit.pdf
Northeast Oregon Network
The NEON website includes information about local health outreach efforts and a training schedule for CHW trainings.
www.neonoregon.org
Oregon.Gov/Office of Equity and Inclusion
The website includes information on State approved trainings and certification requirements.
www.oregon.gov/oha/oei/Pages/thw-approved.aspx
References
• American Public Health Association (APHA). (2016). Community Health Workers. Retrieved from the APAH Community Health Workers webpage at: https://www.apha.org/apha-communities/member-sections/community-health-workers
• Bovbjerg, R.R.; Eyster, L.; Ormond, B.A.; Anderson, T.; Richardson, E. (2013). Integrating Community Health Workers into a Reformed Health Care System. Retrieved from The Urban Institute online at: http://www.urban.org/sites/default/files/alfresco/publication-pdfs/413070-Integrating-Community-Health-Workers-into-a-Reformed-Health-Care-System.PDF
• Bureau of Labor Statistics. Occupational Employment and Wages, May 2015: Community Health Workers. Retrieved from United States Department of Labor website at: http://www.bls.gov/oes/current/oes211094.htm
• PayScale Human Capital. Community Health Worker Salary (United States), 2016. Retrieved from PayScale website at: http://www.payscale.com/research/US/Job=Community_Health_Worker/Hourly_Rate
• Panning, A. (2015). Community Health Worker Financing. Retrieved from Northwest Regional Primary Care Association website at: http://www.nwrpca.org/news/211392/Community-Health-Worker-Financing.htm