Redesigning the Health Care Team:

Integrating Community Health Workers within Affordable Care Act Implementation

May 9, 1013

Institutional Buy-In

May 9, 2013

Romelia Corvacho, CHW AdministratorFamily Medicine Department CHW Program

Bronx Lebanon Hospital Center

Department of Family Medicine Community Health Worker Program at Bronx Lebanon Hospital Center

Department of Family MedicineBronx Lebanon Hospital Center

BLHC Family Medicine CHW Program Leadership

Douglas Reich, MD, Family Medicine Department Chair

Romelia Corvacho, CHWCHW Administrator

Maria Murphy, CHWCHW Supervisor

CHW Program at the Department of Family Medicine

BLHC needed to create a more innovative and coordinated

approach to address the health problems of the South Bronx

community.

“Old Model of Care”

Past methods ineffective

Clinical approach to patient interaction is limited

RNs, LPNs, PCTs were all bringing the same clinical approach

to the care team.

Clinicians have limited time

CHWs Responsible for Care Management

Nurse Care model was too costly

Nurses tend not to be from the community they serve

Ideally CHWs should be employees, not contractors

The Beginning of the Model

Family Medicine Department CHW Program:

This program was started by Dr. Douglas Reich and Dr. Paul Beach in 2008. The program started with five CHWs. It was funded by a two-year grant by the New York State Health Foundation.

The Community Health Worker (CHW) program assists in patient management of chronic illnesses through community based education and support, including home visits and shared medical visits (SMV).

How to Begin a CHW Program

Leadership & Supervision

Creating the policy and procedure infrastructure

Establishing CHW Position and Recruitment

Identify roles and members of the Interdisciplinary Team

Operational Leadership & Supervision

Program Director or Administrator

Skilled Manager essential

Former CHW’s ideal

Policy & Procedure Infrastructure

Drafting a Policy & Procedures Manual

Objectives & Goals using S.M.A.R.T.E.R. criteria

Compliments existing HR policies and in-force Collective Bargaining Agreements

It’s a “living document”, responsive to change

Semi-Annual Work Productivity Analysis provides on-going evaluation.

Establishing CHW Positions

Establishment of CHW position within the hospital

Development of job descriptions

Ideally CHWs should be employees not contractors

Recruitment of CHWs

CHWs with attributes for communication, advocacy, and

support

Experience more desirable than traditional education

credentials

Communication and diplomacy sought after

CHW Training

Core Competency Training

CHW training in adult education Participatory Experiential Interactive

CHWs receive targeted in-service on disease topics by our physicians

On Going Training

CHWs receive “coaching” and support

Organization Culture

Commitment to CHW by Administration

CHW programs financed by grants and hospital budget

CHW provided with initial & ongoing training

CHW part of Residents and Attendings training

CHW career ladder provided

CHW supervision and support provided

CHWs Recognized Members of the Care Team

CHWs viewed as a primary part of the medical team

Fully integrated in planning and operations

Department of Family Medicine Interdisciplinary Team

Departmental Hierarchy

Thank you And Adios

romrodri@bronxleb.org