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
Andrea Gelzer, M.D., M.S., FACP • Has nothing to disclose. 2 • December 4, 2018
Who We Are 3 • December 5, 2018
Vulnerable Populations Require Intensive Support HEALTH ISSUES SOCIAL ISSUES SOCIAL ISSUES Poverty Health literacy Poverty Language barriers Comorbidities Language barriers Education Behavioral health Education MEMBERS WE SERVE MEMBERS WE SERVE Homelessness Substance abuse Homelessness Transportation Polypharmacy Transportation Food access Drug adherence Food access Personal safety Personal safety 4 • 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. 5 • 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 AmeriHealth Caritas Community Care Management Team Members members access care. 6 • December 4, 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. 1 • December 5, 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. 8 • December 4, 2018
We Use Geocoding to Identify Hot Spots Philadelphia County, PA 9 • December 4, 2018
Community Care Management Program Expansion Keystone First (KF) Chester City, PA — Fall 2012. • Philadelphia, PA — Spring 2014. • BCC Select Health (SH) Charleston, SC — Winter 2013. • Spartanburg, SC — Summer 2016. • AmeriHealth Caritas Louisiana (AHC-L) KF Baton Rouge, LA — Summer 2014. • New Orleans, LA — Summer 2016. • AHC-DC Lafayette, LA — Summer 2016. • Shreveport, LA — Summer 2016. • Blue Cross Complete (BCC) Detroit, MI — Summer 2016. • SH Washtenaw, MI — Spring 2018. • Prestige Health Choice (PHC) PHC Orlando, FL — Summer 2017. • Fort Myers, FL — Summer 2017. • Tampa, FL — Summer 2017. • AmeriHealth Caritas District of Columbia AHC-L (AHC-DC) Summer 2018. • 10 • December 4, 2018
We Continue to See Positive Program Results 20% 31% 11% 54% Preventable Total cost of care ER visits Preventable inpatient admissions (medical + pharmacy) readmissions 79% 83% Successful in-person Successful calls with visits with engaged members engaged members Source: AmeriHealth Caritas data results from January 2016 to March 2018. 11 • 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? 12 • December 4, 2018
Lessons Learned • CHWs are extremely effective in engaging members. • Community-based workforce requires supportive leadership. • Provider partners and champions are key. 13 • December 4, 2018
Questions? 14 • December 4, 2018
Thank You! Andrea Gelzer, M.D., M.S., FACP Senior Vice President, Medical Affairs AmeriHealth Caritas November 1, 2018 15 • December 4, 2018
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