Community Health Worker (CHW) Strategies and Local Public Health: Overview and Opportunities Local Public Health Association Meeting May 16, 2013 Carol Berg, Board Member Joan Cleary, Executive Director - Interim Minnesota Community Health Worker Alliance
Introduction to the Minnesota CHW Alliance Building blocks of Minnesota s CHW field Lessons & Next Steps CHW Field Development & the Role of Public Health Agencies Selected resources Presentation Outline
Minnesota CHW Alliance We re a broad-based partnership of CHWs and stakeholder organizations, governed by a 14-member nonprofit board, who work together to address health disparities, help achieve the triple aim and foster healthier communities http://www.mnchwalliance.org/
Objective: Improve access to affordable coverage and quality, culturally-competent care CHW Model Integration Objective: Foster policies that promote healthy people and healthy communities Education MN CHW Alliance Help achieve the Triple Aim, address health disparities, expand & diversify the health care workforce and foster healthier communities through CHW strategies Policy Objective: Advance CHW knowledge & skillset and interprofessional education to better serve Minnesota communities Research Objective: Raise awareness of CHW impacts through research & evaluation
Defining the CHW role Apply their training along with their unique understanding of the life experiences, culture and language of the communities they serve Carry out culturally-appropriate health education, information and outreach Provide direct services (e.g. health screenings, enrollment assistance), cultural mediation and systems navigation Build individual and community capacity Advocate for individual and community needs Work on teams in the community and in agency & provider settings; represent Minnesota s many cultural communities
Trusted members of the communities they serve Educate and connect underserved communities to care, coverage and support Work under different titles and in many different settings Reduce cultural and linguistic barriers to health care and social services; improve quality, cost- effectiveness and cultural competence of care, and expand and diversify our health care workforce CHWs: An Emerging Profession
CHW Functions CHWs help patients of all ages: Prevent costly health conditions, diseases and injuries Access needed care and coverage Avoid unnecessary ER and hospital visits Navigate our complicated health care system Manage chronic illness and maintain quality of life Improve individual and family capacity Foster healthy communities
CHW employer types in Minnesota Community-based Nonprofits Clinics, Hospitals and Health Plans Federally Qualified Health Centers Public Health Departments Dental Services Mental Health Centers Faith-based networks
CHW Profession & Benefits: Recognized by Leading Public & Private Authorities American Public Health Association (APHA) Centers for Disease Control (CDC) Health Affairs Health Resources and Services Administration (HRSA) Institute of Medicine U.S. Dept. of Labor Standard Occupational Classification (DOL) Twin Cities Medical Society
CHWs & Healthcare Reform Centers for Medicare and Medicaid Services Workforce Innovation Grants Patient-Centered Medical Homes Health Insurance Exchanges Three sections of the Affordable Care Act CDC grant (section 5313) to promote positive health behaviors and outcomes in medically underserved communities through Community Health Workers. National Health Care Workforce Commission (Sec 5101) includes CHWs as primary care professionals Area Health Education Centers (sec. 5403 Sec.751) add CHWs to mandate for interdisciplinary training of health professionals
MN CHW Building Blocks Recently recognized by the Agency for Healthcare Research & Quality http://innovations.ahrq.gov/content.aspx?id=3700 CHW scope of practice developed (2004) Standardized, competency-based 11 credit curriculum created by Healthcare Education Industry Partnership, leading to certificate (2003-2005); revised to 14 credit program (2010) Minnesota CHW Peer Network formed (2005) CHW payment legislation successfully introduced (2007) in follow-up to commissioned research on sustainable funding strategies (2006) Minnesota 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 CHW Curriculum Model curriculum was updated in 2010 to a required 14 credit certificate program MnSCU curriculum offered at no charge to postsecondary schools in Minnesota Sold to over 30 organizations outside of Minnesota; now available in online format Credits provide educational pathway for CHWs interested in other health careers
MN CHW Curriculum Role of the CHW Core Competencies (9 credit hours) 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 Role of the CHW Health Promotion Competencies (3 credit hours) Role of CHW Practice Competencies Internship (2 credit hours)
CHW Certificate Program Currently five schools offer the certificate program: Minneapolis Community and Technical College Rochester Community and Technical Collge St. Catherine University, St. Paul South Central College, Mankato (online version) Summit Academy OIC, Minneapolis Online option available (next course offered in August) Normandale Community College and Northwest Technical College, Bemidji to introduce the program in 2013-2014 Over 500 graduates to date
CHW Peer Network Co-chaired by CHWs & sponsored by Wellshare International Established in 2005 in follow-up to CHW focus group research commissioned by the Blue Cross Foundation identified peer support and professional growth as priorities of practicing CHWs Goals: Improve resource sharing and information exchange among CHWs Create opportunities for peer mentoring and support Offer continuing education and professional development http://www.wellshareinternational.org/chwpeernetwork
MHCP CHW Payment Legislation Minnesota Statute (MS 256B.0625, Subd. 49)
Covered Services 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 Clinics Critical Access Hospitals Dentists Family Planning Agencies Tribal Health Facilities Hospitals Indian Health Services Facilities Mental Health Professionals Physicians Public Health Nurses working in a unit of government To learn more about MN CHW coverage policy, contact: Susan.Kurysh@state.mn.us
Assessing Progress, Advancing Opportunities A decade of successful partnerships position MN as a national leader in CHW field development. Focus on integrating and upscaling CHW strategies to help achieve the Triple Aim and reduce health disparities will require both leadership support and systems approaches.
Looking Ahead 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 Incorporate CHW workforce into: - Health care home program - Health Insurance Exchange (as assistors and navigators) -ACO models Build greater awareness of the role and its impacts
CHW Field Development Roles of Local & State Public Health Depts Convenor Catalyst Coordinator/clearinghouse Partner Funder Employer Resource/Technical Assistance Provider Policy expert Inter-agency lead
Integrating the CHW Role into Local Public Health Home Visiting Programs Lead Poisoning Prevention, Environmental Health and Healthy Homes Refugee and Immigrant Health Chronic Disease Prevention and Management SHIP Immunization and Well Child Visits WIC Nutrition and Peer Breastfeeding Support Other opportunities?
Examples: State & Local Public Health Local Public Health: Building on history of employment of wide variety of CHW roles/titles, Seattle King County has commissioned report on comprehensive approach to adoption of CHW strategies across the health dept State Public Health: State-level Offices of CHWs in Massachusetts and New Mexico
Minnesota Spotlight: CHWs and Local Public Health Blue Earth County Dakota County Hennepin County St. Paul Ramsey County Others
Types of Support for the CHW Role by the Mass Dept of Public Health 1) Development and support of CHW Leadership (MACHW) 2) Promotion of CHWs by Commissioner and leadership team 3) Commitment of DPH staff & resources 4) Fundraising support and promotion of funding opportunities 5) Demonstration grants 6) Policy development 7) Employment of CHWs through DPH contracts 8) Training and curriculum development 9) Research and publications 10) Strategic partnerships 11) Convening and leading public-private initiatives 12) National networking and promotion of CHW movement Partnerships Leadership Research Resources Policy & Program
Connect with us on: CHW research and best practices Successful models and results Consulting and technical assistance Networking CHW Supervisor Roundtable Sustainability strategies Evaluation
Trends that Impact the Future of the CHW Field Move from volume-oriented payment to pay for performance/outcomes and total cost of care Workforce needs related to expanded coverage and primary care shortages Demographic shifts with aging baby boomers and growth in populations of color New care delivery and financing models such as health care homes and accountable care organizations Focus on team-based, patient-centered care with everyone working at the top of their license
Trends, cont. Greater recognition of social, environmental and economic determinants of health and use of tools such as community assessments and HIA Need for proven, integrated, lower cost models Increased accountability for reporting and outcomes, leading to wider adoption of best practices to address health disparities Growing body of outcome-based studies that point to effectiveness of CHW strategies to reduce health disparities and improve cultural competence
Conclusion CHW strategies are an integral part of the response to the challenges facing our nation s health. State and local public health agencies can play a vital leadership role in fostering the integration of CHW services in public health systems. They can also serve as a catalyst and partner for the successful adoption of CHW strategies within the health care system.
Selected Resources Community Health Workers Evidence-based Models Toolbox. HRSA Office of Rural Health.2011. Brownstein JN et al. Addressing Chronic Disease through Community Health Workers: A Policy and Systems-Level Approach. CDC. 2011. Cleary J, Lee J and Itzkowitz V. CHWs in Minnesota: Bridging Barriers, Expanding Access, Improving Health. 2010. www.bcbsmnfoundation.org Johnson, D, Saavedra, P, Sun, E, Stageman, A, Grovet, D, Alfero, C, Kaufman, A. 2011. Community Health Workers and Medicaid Managed Care in New Mexico. Journal of Community Health. doi: 10.1007/s10900-011-9484-1 Pathways Model http://www.innovations.ahrq.gov/content.aspx?id=2040 Wilder Research Center CHW Assessment and ROI http://reg.miph.org/2012cancersummit/presentationpdfs/diaz.pdf
Let s partner for better health! For more info, contact the MN CHW Alliance Carol Berg, Board Member cberg@ucare.org Joan Cleary, Executive Director-Interim joanlcleary@gmail.com Thank you!
Discussion and Q & A Where could CHW strategies make a difference in your agency s outcomes and effectiveness? What are some starting-points for integrating CHW approaches? Who is interested in exploring opportunities for addressing community and agency needs through team-based models involving CHWs?