Transcript Slide 1

Scaling Up
Community Health Worker Strategies
Workforce innovation for advancing health equity
and achieving the Triple Aim
Families USA Conference
January 23, 2015
Joan Cleary, Executive Director - Interim
Minnesota Community Health Worker Alliance
Presentation Outline





Introduction: What’s
Keeping You Up at Night?
CHW Role
Overview of Minnesota
CHW Alliance and our CHW
Field-Building Work
Lessons & Observations
Selected resources
What’s keeping you up at night?
Sleepless in the Twin Cities
Integrated Health Systems
• Impact of the Affordable Care Act and becoming an ACO
• Achieving the Triple Aim
• Dealing with the social determinants of health
• Getting more out of fewer resources
East Metro CHW Business Plan Project, MN CHW Alliance, 5/2013
Sleepless in the Twin Cities
Payers
•Cost of care while improving health outcomes for more people
•Addressing the needs of an increasingly disparate membership
•Counteracting and/or addressing the social determinants of
health
East Metro CHW Business Plan Project, MN CHW Alliance, 5/2013
Sleepless in the Twin Cities
Policymakers
• Reducing costs associated with health care and burden on society
• Understanding and addressing the social determinants of health
• Addressing health disparities in culturally-appropriate ways
• Taking a less siloed approach to health care
East Metro CHW Business Plan Project, MN CHW Alliance, 5/2013
Sleepless in the Twin Cities
State Agencies
•Implementing MNsure (the state’s health insurance exchange)
•Best addressing health disparities while reducing costs
•Successful implementation of Patient-Centered Medical Homes
(“Health Care Homes” in Minnesota)
East Metro CHW Business Plan Project, MN CHW Alliance, 5/2013
Team-based CHW Strategies:
Health Reform Trifecta!

Advance health equity

Help achieve the Triple Aim*…improving patient experience
(including quality and satisfaction), improving population
health, reducing per capita health care costs

Grow and diversify our health care and public health
workforce
*Institute for Healthcare Improvement
CHW Role
Who are Community Health Workers?
Trusted, trained and knowledgeable
frontline health workers who share the
culture and/or life experience of the
communities they serve
Educate and connect underserved
communities to care, coverage and support
Provide outreach, advocacy, patient
education, care coordination, navigation,
social support and informal counseling
Address social determinants of health,
working upstream and downstream
An emerging
workforce
CHWs
Tribal CHRs
Lay Health Advisors
Promotoras
Patient
Navigators
Community
Health Advocates
Adapted from NM Dept of Public Health presentation
Community
Educators
Care Guides
Outreach Workers
CHWs are uniquely equipped
They typically reside in the communities they serve, and share
the same language, ethnic, cultural and educational background
Health &
Social
Service
Systems
Adapted from NM Dept of Public Health presentation
CHWs
Community
Focus on social aspect of care
Providing culturallyresponsive, cost
effective health
information
Teaching and supporting
families to learn the
knowledge/skills needed
to manage treatment
and prevent disease
Advocating for services
to meet community
needs
Adapted from NM Dept of Public Health presentation
Linking communities to
health/social service
systems of care and
helping them to
navigate the systems
Empowering individuals
and communities to
advocate for their
health
CHW strategies:
Evidenced-based best practices
to address health disparities
Effectively address barriers related to culture, language, literacy,
ability, place, socioeconomic and other factors
Increase access and improve quality, cost-effectiveness and
cultural competence of care
Organize and advocate for healthier communities
Well-documented outcomes: asthma, diabetes, HIV/AIDS,
hypertension, maternal and child health as well as cancer
outreach and immunizations
Examples of evidence-based CHW models
Molina Health, New Mexico
• Reduced ER utilization
Community Health Access Program (Pathways) Ohio
• Improved birth outcomes
Sinai Pediatric Asthma Intervention, Illinois
• Improved child asthma management, reduction in asthma symptoms and ER use
GRACE Model, Indiana and IMPaCT, University of Pennsylvania
• Reduction in hospital readmission rates and improve post-hospital outcomes
Arkansas Community Connectors Program
• Averted nursing home placement
Recognized by leading public &
private authorities
American Public Health Association (APHA)
Centers for Disease Control (CDC)
Centers for Medicare and Medicaid Services (CMS)
Health Affairs
Health Resources and Services Administration (HRSA)
Institute of Medicine
U.S. Dept. of Labor Standard Occupational Classification (DOL)
What are we learning from recent CHW
studies on Return on Investment?
Carl Rush, “CHWs: A National Perspective,” Indiana CHW Coalition Community Symposium, 10/15/2012
Introduction to Alliance and
Our CHW Building Blocks
About the Alliance
We’re a broad-based partnership of CHWs and stakeholder
organizations, governed by a 13-member nonprofit board.
OUR VISION
Equitable and optimal health outcomes for all communities
OUR MISSION
Build community and systems’ capacity for better health through
the integration of community health worker strategies
http://www.mnchwalliance.org/
What are we trying to accomplish?
Advance
Triple Aim
Reduce
health
inequities
Full integration
of CHWs in MN
systems of care
Adapted from NM Dept of Public Health presentation
Objective:
Improve access to
coverage and care
Education
Objective:
Advance CHW knowledge &
skillset and interprofessional education to
better serve Minnesota
communities
MN CHW
Alliance
Workforce
Development
Help achieve the Triple Aim,
address health disparities,
expand & diversify the health
care workforce and foster
healthier communities
through CHW strategies
Objective:
Foster policies that promote
healthy people and healthy
communities
Policy
Research
Objective:
Raise awareness of CHW
impacts through research &
evaluation
MN CHW Building Blocks
Recognized by the Agency for Healthcare Research and Quality
CHW scope of practice developed (2004)
Statewide standardized, competency-based 11 credit curriculum
created by Healthcare Education Industry Partnership, leading to
certificate (2003–2005); revised to 14 credit program (2010)
MNCHW Peer Network formed (2005) for continuing education
CHW payment legislation successfully introduced (2007) in follow-up to
commissioned research on sustainable funding strategies (2006)
MN CHW Alliance formed as outgrowth of CHW Policy Council (2010)
and incorporated as nonprofit (2011)
Minnesota CHW Scope of Practice
Role 1: Bridge the gap between communities and the health and
social service systems.
Role 2: Promote wellness by providing culturally appropriate
health information to clients and providers.
Role 3: Assist in navigating the health and human services system.
Role 4: Advocate for individual and community needs.
Role 5: Provide direct services.
Role 6: Build individual and community capacity.
MN Standardized CHW Curriculum
Model statewide curriculum based in higher education
Offered at no charge to post-secondary schools in Minnesota
Sold to over 30 organizations outside of Minnesota; online version
now available
Credits provide educational pathway for CHWs interested in other
health careers
Leads to certificate recognized by MN Dept of Human Services
Over 600 graduates to date
Curriculum is competency-based
Core Competencies: 9 credits
• Role, Advocacy and Outreach – 2
• Organization and Resources – 1
• Teaching and Capacity Building – 2
• Legal and Ethical Responsibilities – 1
• Coordination and Documentation - 1
• Communication and Cultural Competency - 2
Health Promotion Competencies: 3 credits
Practice Competencies – Internship: 2 credits
MN CHW Payment Legislation Timeline
2007 Legislation
12/19/07: Federal approval received
Minnesota Health Care Program (MHCP) enrollment criteria:
CHW certificate from school offering MnSCU-approved curriculum
Supervised by a physician or advanced practice registered nurse
Grandfathering provision
2008 Amendment
3/18/09: Federal approval of expansion of CHW supervision to the
following provider types:
Certified public health nurses within a unit of government and dentists
2009 Amendment
Federal approval of supervision by Mental Health Professionals
MHCP CHW
payment legislation
Minnesota Statute (MS 256B.0625, Subd. 49)
CHW covered service:
Diagnostic-related patient education
Signed diagnosis-related order for patient education in patient
record
Face-to-face services, individual and group
Standardized education curriculum consistent with established
or recognized health or dental care standards
Document all services provided
Provider types authorized to
bill for CHW services
• Advanced Practice Nurses
• Hospitals
• Clinics
• Indian Health Services Facilities
• Critical Access Hospitals
• Mental Health Professionals
• Dentists
• Physicians
• Family Planning Agencies
• Public Health Clinic Nurses
• Tribal Health Facilities
To learn more, contact: [email protected]
What’s Next?
Priorities
Fully integrate the CHW role into state-funded health and human services
programs, local public health and human services, and health care
systems redesign efforts such as MN’s Accountable Communities for Health
model
Continue to incorporate CHW workforce into:
• Health care home program
• Health Insurance Exchange (as assistors and navigators)
• ACO models
Increase awareness of the role and its impacts
Example: Success with CHWs online tool kit initiative
Partner and grow to build our capacity to achieve our vision
Health system challenges and trends present
opportunities for CHWs to make a difference
Increasingly diverse and rapidly aging population
ACA is increasing access to thousands of uninsured
Focus on Triple Aim and team-based care
Payment shift from fee-for-service to value-based purchasing and
total cost of care
Primary care shortage
Health equity growing in priority
New England Comparative Effectiveness Advisory Council:
Final Report & Action Guides, July 2013
BEST PRACTICE RECOMMENDATIONS INCLUDE:
Getting started
States and organizations can choose comprehensive or incremental
approach to CHW implementation
Program Funding
Payors and providers need to work together on stable funding
mechanisms, including CHW strategies in new payment models as well as
existing case management and home visiting funding streams
CHWs: A Review of Program Evolution, Evidence on Effectiveness and Value, and
Status of Workforce Development in New England
Lessons &Observations
CHW movement is accelerating
under health reform
•
•
•
•
•
•
•
•
•
Find key starting-points, partners and policy levers
Recognize that CHW education is key to CHW financing
Champions are needed at multiple levels
Active involvement of CHWs is critical…build CHW
leadership
Practice transformation takes time
Allies and working team-based models help address
skepticism and occupational turf
Success stories AND data are important
State-level infrastructure needs to be created to
support an emerging CHW profession
Connect with CHW allies through APHA CHW Section
Implementing CHW Strategies
City-wide and regional partnerships
Example: Super Utilizers
Local public health agencies
Example: Family home visiting
Hospitals & integrated health systems
Example: Patient-centered medical homes, ER
Community clinics
Example: Outreach and education to improve screening rates
Social service agencies, housing providers, schools
Example: Address unmet health and social needs, link to coverage and care
Companies
Example: Occupational Health Dept
Selected resources
Allen C, Brownstein JN et al. States Implementing CHW Strategies: A Technical
Assistance Guide. CDC. 2014.
http://www.cdc.gov/dhdsp/programs/spha/docs/1305_ta_guide_chws.pdf
ASHTHO CHW Certification/Training Standards. 12/31/2014.
http://www.astho.org/public-policy/public-health-law/scope-of-practice/chwcertification-standards/
Cleary J, Lee J and Itzkowitz V. CHWs in Minnesota: Bridging Barriers, Expanding
Access, Improving Health. Blue Cross and Blue Shield of Minnesota Foundation.
2010. www.bcbsmnfoundation.org
Pathways Model www.innovations.ahrq.gov
Wilder Research Center. CHWs in the Upper Midwest.2012. www.wilder.org
For more information:
Joan Cleary, Executive Director
Minnesota Community Health Worker Alliance
612-250-0902
[email protected]
www.mnchwalliance.org
Thank you!