Integrating Community

Health Workers (CHWs)

in Your Practice

April 27, 2016

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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: lladendorff@neonoregon.org

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