Using Community Health Workers To Improve Patient Outcomes: A Health - - PowerPoint PPT Presentation

Using Community Health Workers To Improve Patient Outcomes: A Health Plan Experience

Andrea Gelzer, M.D., M.S., FACP

Senior Vice President, Medical Affairs AmeriHealth Caritas November 1, 2018

#PCORI2018

2 • December 4, 2018

Andrea Gelzer, M.D., M.S., FACP

• Has nothing to disclose.

3 • December 5, 2018

Who We Are

4 • December 4, 2018

Vulnerable Populations Require Intensive Support

SOCIAL ISSUES

MEMBERS WE SERVE

Poverty Language barriers Education Homelessness Transportation Food access Personal safety

MEMBERS WE SERVE

SOCIAL ISSUES

Poverty Language barriers Education Homelessness Transportation Food access Personal safety

HEALTH ISSUES

Health literacy Comorbidities Behavioral health Substance abuse Polypharmacy Drug adherence

5 • December 4, 2018

Our Community Care Management Teams Serve Those At Highest Risk

Members with disproportionate utilization of services and cost with unmet care management needs. Members with chronic health problems who have ongoing care coordination needs. Members with episodic health needs who have an occasional need for care coordination. Members with a prevention and wellness focus.

6 • December 4, 2018

Community Care Management Teams:

• Provide long-term, high-touch, face-to-face engagement.
• Deploy multi-disciplinary resources in the community,

including community health workers.

• Address unmet social and behavioral health needs.
• Support the development of member self-management and

self-advocacy skills.

• Collaborate with providers and community partners to help

members access care.

AmeriHealth Caritas Community Care Management Team Members

1 • December 5, 2018

We Use Community Health Workers To:

• Find and engage members who haven’t accessed care.
• Support numerous care management initiatives.
• Establish rapport with members and build trust.
• Help members identify and address barriers to care.
• Collaborate with providers and community resources.

8 • December 4, 2018

Asthma Navigator Program

• Use certified asthma navigators.
• Conduct in-home environmental assessments.
• Education about asthma trigger and avoidance techniques.
• Connect member to community resources.

9 • December 4, 2018

We Use Geocoding to Identify Hot Spots

Philadelphia County, PA

10 • December 4, 2018

Community Care Management Program Expansion

BCC SH PHC AHC-L AHC-DC KF

Keystone First (KF)

• Chester City, PA — Fall 2012.
• Philadelphia, PA — Spring 2014.

Select Health (SH)

• Charleston, SC — Winter 2013.
• Spartanburg, SC — Summer 2016.

AmeriHealth Caritas Louisiana (AHC-L)

• Baton Rouge, LA — Summer 2014.
• New Orleans, LA — Summer 2016.
• Lafayette, LA — Summer 2016.
• Shreveport, LA — Summer 2016.

Blue Cross Complete (BCC)

• Detroit, MI — Summer 2016.
• Washtenaw, MI — Spring 2018.

Prestige Health Choice (PHC)

• Orlando, FL — Summer 2017.
• Fort Myers, FL — Summer 2017.
• Tampa, FL — Summer 2017.

AmeriHealth Caritas District of Columbia (AHC-DC)

• Summer 2018.

11 • December 4, 2018

We Continue to See Positive Program Results

Preventable inpatient admissions

20%

ER visits

31%

Preventable readmissions

54%

Total cost of care

(medical + pharmacy)

11%

Successful in-person visits with engaged members

79%

Successful calls with engaged members

83%

Source: AmeriHealth Caritas data results from January 2016 to March 2018.

12 • December 4, 2018

Barriers

• What is the right level of training?
• How do we ensure personal safety?
• How do we ensure health safety?
• How do we locate associates in the field?

13 • December 4, 2018

Lessons Learned

• CHWs are extremely effective in engaging members.
• Community-based workforce requires supportive

leadership.

• Provider partners and champions are key.

14 • December 4, 2018

Questions?

15 • December 4, 2018

Thank You!

Andrea Gelzer, M.D., M.S., FACP

Senior Vice President, Medical Affairs AmeriHealth Caritas November 1, 2018