Community Health Workers: Enhanced and Sustainable Roles Under New - - PowerPoint PPT Presentation

Community Health Workers: Enhanced and Sustainable Roles Under New Models of Care and Payment

6/28/2017

Susan A. Chapman, Jacqueline Miller, Jennifer Schindel Healthforce Center at UCSF

Background

• Link community members to clinical services
• Advocate for communities
• CHW role provides entry level jobs
• More opportunities arise for CHWs with new payment models

and models of care

• This study synthesized key issues and developed actionable

guidelines for integrating CHWs into health care teams and new models of care Community Health Workers (CHWs) play a vital role in the delivery health related services, particularly to vulnerable populations

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Funding: Blue Shield of California Foundation

Methods

• Synthesis focused on employment data, roles, training,

certification, payment, and sustainability

• Programs visited: FQHCs, managed care plans, county health

delivery systems, and rural district hospitals

• Phase 2 will culminate with tools and guidelines to enhance

CHW utilization throughout the state and elsewhere

• Project guided by state stakeholder group

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• Two phases:
• Synthesis of previous work on CHWs
• Site visits to a variety of programs utilizing CHWs

Challenges with Traditional Workforce Planning for CHWs

• Data – Analyses of current health care workforce
• Strategy – Overarching workforce planning approach
• Planning – Approach to create pipelines to fill future workforce

needs

• Evaluation – Ability to monitor effectiveness of the plan2
• This model is built on a premise that there is an existing role

in healthcare organizations with corresponding data – this is not the case for the CHW role

• 2. Drake, S., Pawlowski, U., Riley, V. (2013). Developing and Effective Health Care Workforce Planning Model. American Hospital Association.

Traditional workforce planning models center on an approach that includes:

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CHW Data and Sources

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SOC Code Occupatio nal Title Estimated Employment 2012 Projected Employme nt 2022 Numeric Change 2012-2022 Percent Change 2012-2022 Annual Average Percent Change 21- 1094 Community Health Workers 6,600 7,900 1,300 19.7% 2.0%

California Occupational Employment Projections 2012 - 2022

Sources: U.S. Bureau of Labor Statistics' Current Employment Statistics (CES) March 2013 benchmark, Quarterly Census of Employment and Wages (QCEW) industry employment, and Occupational Employment Statistics (OES) data.

Policy Brief Findings

• Disseminate research demonstrating ROI for CHW integration
• Identify best practices of successful CHW integration
• Translate CHW demand into tangible jobs-to-be-filled
• Enhance CHW opportunities through policy development, funding

initiatives, and payment reform

• Identify sustainable funding models
• Create enhanced training and certification pathways to employment,

but preserve community-based Promotora role1

• 1. https://healthforce.ucsf.edu/sites/healthforce.ucsf.edu/files/publication-pdf/BSCF%20CHW%20Policy%20Brief%20Final%201.4.17%5B1%5D.pdf

Research to date has shown that effective workforce planning support in California could benefit from the following efforts:

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Site Visit Interviews

• 44 individuals interviewed; 45 mins – 1 hour
• Interviewees:
• Program Directors, Medical Directors, Executive Directors
• Outreach Coordinators & Directors; CHW Leads, Supervisors, &

Managers

• Operations Directors, Curriculum Developers
• CHWs, Health Navigators, Promotoras, Community Health

Outreach Specialists, Patient Navigators, Health Educators

• Providers; physicians, RNs

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5 sites in California

Site Visits

• Community Health Center Network (CHCN) is a non-profit Medi-Cal managed

care organization comprised of eight health centers in Alameda and Contra Costa counties with over 80 locations.

• Care Connections Program (CCP) is a community health worker-integrated,

primary care-embedded care management program for Los Angeles County’s (LAC’s) sickest and most vulnerable patients.

• Inland Empire Health Plan (IEHP) is a non-profit Medi-Cal and Medicare health

plan serving residents of Riverside and San Bernardino counties.

• La Clínica de la Raza is a community health center that provides primary health

care and additional services to residents of Alameda, Contra Costa, and Solano counties.

• Transitions Clinic Network (TCN) is a national network of medical homes for

those with chronic diseases recently released from prison.

• Kaweah Delta Health Care District (KDHCD) is the largest hospital in Tulare

County spanning eight campuses in its healthcare district.

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Site Visit Findings

• Recognize that job descriptions will vary – dependent on the site

and the site’s needs

• At least some, if not the majority, of training will take place at the
• rganizational level
• Facilitate collaboration between clinical community health workers

and the traditional, community-facing Promotora

• “When you invest in a CHW, you invest in the community.”
• Medical Director

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To achieve sustainable employment and integration of the CHW role into health care teams:

Theory of Change Framework

We use a Theory of Change framework to create a more robust, causal model that captures:

• Factors needed to successfully integrate CHWs into care teams across

the varied conditions and CHW employer settings: community-based

• rganizations, care delivery organizations, county initiatives, and health

plans.

• Interventions and actions needed to promote CHW workforce

development and enhance clinical readiness to effectively and appropriately integrate the CHW role.

“Theory of Change is a rigorous yet participatory process whereby groups and project stakeholders identify the conditions they believe have to unfold for their long-term goals to be met. These conditions are modeled as outcomes, arranged graphically in a causal framework.” – www.theoryofchange.org

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Backwards Mapping to Long Term Goal

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Clinical entities demonstrate full commitment and requirements to directly address social determinants

• f health in care

delivery models

Elevated recognition of the CHW role as a spectrum of job titles with a collective function centered on delivering person-centered care across the continuum of community through clinical settings

“Doctors and social workers do not go back into to the community to address more upstream issues. Narratives [and actions] of CHWs are more powerful than what other providers could do. They are the tools for change and

• advocacy. – Medical Director

“We are like the thread in the material, you don’t always see it but it’s important. You are always winding and tying things together from the community to the medical field.” — Community Health Worker

“Our healthcare delivery system is not mature yet in its efforts to truly ‘do’ population health and complex care management.” — Medical Director “A change in culture needs to happen with adding an extra team member and re-adjusting workflows to make sure that CHWs are integrated.” — Program Planning Leader

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Care delivery

• rganizations are

fully primed to integrate a patient- centered non-clinical CHW role into coordinated care

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“The clinic wants you do fit into a cookie cutter thing, but that’s not where the job is. Not everything is easy, and not everything is written out. You have to learn how to work outside of the box.” — Community Health Worker “In general, the clinical community often does not trust

• CHWs. In the beginning, there was some difficulty with

this – the providers and other clinical people were guarding their patients.” —Nurse Manager

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CHW model of care is fully respected and established within care delivery models addressing social determinants of health

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“CHWs in complex care teams need to be [directly employed by the organization] just like the others in care teams. Otherwise, there is too much fragmentation.” — Senior Medical Director

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Provider and payer systems integrate CHW employment into cost of care

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ACTIONS: Building the foundation for successful CHW/Promotora integration into clinical care teams

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Contact Information

• Susan Chapman
• (415) 502 - 4419
• susan.chapman@ucsf.edu
• Jacqueline Miller
• (415) 502 - 4291
• jacqueline.miller@ucsf.edu
• Jennifer Schindel
• jennschindel@gmail.com

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