CHW LEADS Presented by: Carolina Nkouaga, MPH Director, Strategic - PowerPoint PPT Presentation

CHW LEADS Presented by: Carolina Nkouaga, MPH Director, Strategic Development UNM HSC Office for Community Health

What is CHW LEADS? CHW LEADS integrates CHWs into care teams in patient care and community settings to screen for and address the adverse social determinants of health affecting Medicaid recipients.

CHW LEADS CH CHW Primary Care Emergency Department Social Services Agencies and Re-entry Resource Center and Pediatric ED Clinics

CHW LEADS COLLABORATION The University of New Mexico Health Sciences Center, Office for Community Health (UNM OCH) will collaborate with the Southwest Center for Health Innovation (SWCHI) and the Human Services Department (HSD)/Medical Assistance Division (MAD) to fu further de develop, p, evalua uate, an and di dissemina nate the model for integration of Community Health Workers (CHW) into patient care sites and communities to improve population health outcomes and reduce healthcare costs for Medicaid recipients.

FUNDING greement – Gv Gvmt Se Services Agr Cost Share Match $300K HSD MAD $300K UNM HSC OCH “think tank”, model development, evaluation, model testing & implementation dissemination, training

MAIN ELEMENTS OF COLLABORATION Model Refinement Expansion to Payment System & Sustainability New Sites Technical Assistance CHW Training Dissemination

CHW LEADS WHY IS THIS MODEL IMPORTANT?

CHW LEADS Social Determinants of Health Source: WI Public Health Institute

CHW LEADS ADVERSE Social Determinants of Health Well Rx Survey Responses (N = 3,048)

CHW LEADS Conceptual Model

COMMUNITY & CAMPUS-BASED TRAINING EDUCATIONAL LADDERS and CAREER PATHWAYS Health Careers Certificate in Graduate and Professional Associates Degrees Bachelors Programs Exploration Community Health Health Sciences Programs • CHW Core Training Health Education Rural YEP/UNM - H • • Community and Public Masters and PhD Programs • • • Aligned w/state Social Work Dual enrollment Health • • certification standards; Public Health Summer institute • Human Services • • Aligned w/national C 3 Family & Consumer • Linked to STEM , (common core) standards Sciences HOSA Optional additional training/certification (CNA , Nursing , Allied Health , & Other Clinical Educational Pathways EMT , LADAC)

CHW LEADS CHW SCOPE AND Core Competency #11: Clinical Support (optional) COMPETENCIES IN NEW MEXICO Core Competency #10: Core Competency #3: Community Knowledge Interpersonal Skills & Assessment Core Competency #9: Core Competency #4: Community Health Health Coaching Outreach Core Competency #8: Core Competency #5: Technical Teaching Service Coordination Core Competency #7: Core Competency #6: Advocacy Capacity Building Source: NM DOH OCHW

CHW LEADS HOW ARE CHWs FUNDED?

CHW LEADS PAYMENT MODELS Desirable Not Desirable Not Desirable Budget Models/ Cost Based Fee for Service PMPM/ Reimbursement Bundled Payment Averages don’t allow for High Volume/Low Quality Predictable Staffing with Ability to high-needs patients Address Population Health CHW LEADS models, separate from the medical payment system, can focus on OUTCOMES vs VOLUME

CHW LEADS RESOURCES Government General Foundation grants and operating grants contracts dollars

CHW LEADS IMPORTANCE OF INTEGRATING CHWS INTO CLINICAL SETTINGS

CHW LEADS ↑ EXPERTISE/ ↓ BURDEN ON THE CLINICAL TEAM

CHW LEADS ADDRESSING SOCIAL NEEDS

CHW LEADS COST SAVINGS 8.0% 7.0% 6.0% Comprehensive 5.0% CHW 4.0% Patient Centered Medical Home 3.0% 2.0% 1.0% 0.0% Year 1 Year 2 Year 3

CHW LEADS WH WHAT ARE THE BARRIERS?

CHW LEADS Div ivers erse e and nd Flex Flexib ible le CHWs CH Ws are SD SDoH Fund Funding ing Mec echa hanis nisms SP SPECIALISTS STS Ong Ongoing ing Sa Saves es tim ime e Technical Assistance Te and $$$ an Empl Em ploym yment/Financi cing Lack Lac k of Fam amiliar arity No Not used used to Dis istra tractio tion n to to Addr Addressing g SD SDoH Hea ealth lth Sy System tem?

CHW LEADS QUE QUEST STION ONS? S?

CHW LEADS EV EVID IDEN ENCE A E AND RES RESOURC RCES ES

Evidence Handout Slides: Well Rx Survey Responses (N = 3,048) WellRx We We WellRx : 11-question instrument used to screen 3048 patients for social determinants in 3 family medicine clinics over a 90-day period. ROI Resu Re sults: s: 46% 46% of patients screened positive for at least 1 area of social need • 63% 63% of those had multiple needs. • CDC The WellRx pilot demonstrated that it is feasible for a clinic to implement such an assessment system, that the assessment can reveal important information, and that having information about patients' social needs improves provider ease of practice. Other Sources Page-Reeves, et al. (2016). Addressing social determinants of health in a clinic setting: The WellRx Pilot in Albuquerque, New Mexico. The Journal of the American Board of Family Medicine , 29 (3), 414-418.

Evidence Th The Patient-Ce Centered Medical Home (PCM CMH) model 8.0% demonstrated that processes of care can be improved while unnecessary care, such as preventable emergency department 7.0% utilization, can be reduced through better care coordination. Comprehensive 6.0% Handout CHW CH CHW Leads, s, or the “Integrated Primary Care and Community 5.0% Support (I-PaCS)” model, which integrates community health 4.0% Patient workers (CHWs) into primary care settings, functions beyond 3.0% Centered improved coordination of primary medical care to include Slides: management of the social determinants of health. Medical Home 2.0% 1.0% The expected cost impact of the I-PACS CHW model suggests 0.0% that: Year 1 Year 2 Year 3 hospital costs decrease approximately 70% for the high- • WellRx We risk patients, 40% for moderate risk individuals; decrease in emergency services of 61% for high-risk, 25% • for moderate-risk, and 10% for low-risk patients; increased utilization of primary care services with costs • RO ROI projected to increase 20% for primary care and 10% for specialty care. Laboratory services are expected to increase with increased monitoring of clinical measures. CDC In sum, the Fig igure proje ojects the antic icip ipated annual l savin vings by y the thir ird ye year at 1.4% for for the PCMH MH and 7.0% for for the I-Pa PaCS CH CHW model. O ur estimates indicate that the PCMH and CHW models can be complementary, the latter helping the former realize a far greater cost savings. Other Sources Moffett, M. L., Kaufman, A., & Bazemore, A. (2018). Community Health Workers Bring Cost Savings to Patient-Centered Medical Homes. Journal of community health, 43(1), 1-3.

Evidence The evidence base demonstrating the effectiveness of integrating CHWs on clinical care teams is very strong. Research studies examining this intervention have had strong internal and external validity, the Community Preventive Services Task Force concluded that integrating CHWs on clinical care teams is effective, and trials of interventions that integrated CHWs have Handout been replicated with positive results. Health Impa pact Integrating CHWs on clinical care teams or in the community as part of cardiovascular disease (CVD) prevention programs can help program Slides: participants lower their blood pressure, cholesterol, and blood sugar levels; reduce their CVD risks; be more physically active; and stop smoking. 2 It can also improve patient knowledge and adherence to medication regimens and improve health care services. 2 Health Dispa parity Impa pact By design, the CHW model seeks to eliminate health disparities because the populations served usually include people who have more barriers to care. 3 A WellRx Community Preventive Services Task Force review found that most studies on CHWs focused on underserved populations and concluded that the CHW model can be effective in improving health and reducing health disparities related to CVD. 2 ROI Ec Economic Impa pact A review by the Community Preventive Services Task Force concluded that interventions that integrate CHWs on clinical care teams to prevent CVD are cost-effective. 2 The median cost of intervention was $329 (range: $98 to $422) per person per year, with the main cost drivers being CHW time, costs for training and supervision of CHWs, and cost for any additional interventions or CD CDC staff. The median change in health care costs after a CHW intervention was a reduction of $82 (range: -$415 to $14) per person per year. LINK: CDC COMMUNITY HEALTH WORKER TOOLKIT Other Sources https://www.cdc.gov/dhdsp/pubs/guides/best-practices/chw.htm https://www.cdc.gov/dhdsp/pubs/toolkits/chw-toolkit.htm