Community Health Workers is to Recruit and Retain Patients - PowerPoint PPT Presentation

“The purpose of Community Health Workers is to Recruit and Retain Patients”

Something about Los Angeles • L A Dept of Health Services = Second largest safety net health system in the nation + LA Dept of Mental Health • $4 billion budget - ~ $1 billion is provided by LAC general fund • 24,000 DHS workers, 3,000 DMH workers • 800,000 patients annually in directly operated facilities • 2.7 million ambulatory care visits , 280,000 emergency department, 230,000 urgent care visits, and 75,000 inpatient admissions • Four nationally-recognized hospitals, academically affiliated with USC and UCLA Schools of Medicine • 19 outpatient centers and financially supports 160 community- based clinics • Payer mix: 52% uninsured of whom one-third will gain Medicaid in 2014 (many will be ineligible) • 62% Latino, 13% African-American, 9% White, 6% Asian, 10% other • 65% of DHS users have a household income < $10,000

Core Skill Sets Navigate – Health, not just healthcare – how to eat, live, work in a healthy environment  Support self – care such as healthy nutrition, exercise programs, manage a chronic illness  Community resources for housing problems, environmental concerns, hazards on the job, domestic or community violence  Employment issues or legal documentation  Support groups, education resources, etc. Integrate – Physical and Mental Health: patient education, care management, RECOVERY MODEL  Provide linkage both to physical, mental and substance abuse treatment services, as well as community supports- Coordinate - Consolidate one common wellness/health goal across all service systems and identify integrated objectives and strategies for enhancing individual outcomes • Setting up appointments with their main doctor or nurse practitioner for regular check ups  Making sure they get their medicines when they need them  Following up after a hospitalization or serious illness – staying in contact  Making sure they get screening tests in a timely manner such as mammograms or blood work  Making sure that patients are signed up for a care plan that helps pay for the service tc.

PATIENT- CENTERED MEDICAL HOME Enhanced Access - Convenient access to clinical care not only through clinic visits but also via telephone and other modes of communication. Patients will know who their providers are and how to contact them when they need something. Self-Management Support – Learn about the issues that affect the patient’s ability to improve their access to health care such as family and work obligations, transportation barriers. Learn about resources in the community for the patient to improve their health through better nutrition, safety, exercise, improved housing, etc. Patient Tracking – Improve specialty care access and streamline the referral process throughout the system. Performance Feedback – Reduce no-show rates, simplify patient scheduling, reduce wait times, same day appointments – and many other indications that services are improving..

Patient-Centered Integrated Medical Home Licensed Clinical Social Worker One Physician or 0.5 Clerk Nurse Practitioner Primary Primary Care Health Coordinator Provider Care Team 1.5 Certified Medical Assistants per provider or Community Health Worker or LVN or other? Substance Abuse 0.2 Nurse per provider = Care Giver Service Provider 0.2 Nurse per provider = Care Manager Psychiatrist

Los Angeles County DHS Care Model LAC+USC Medical Harbor-UCLA Medical Olive View Medical Center Center Center Acute Care Assessment Acute Care Assessment Acute Care Assessment Team Team Team • Nurse Practitioner • Nurse Practitioner (NP) • Nurse Practitioner • Psychiatric Social • Psychiatric Social • Psychiatric Social Worker Worker Worker 300 Chronic Medical Illness Patients (CMI) 2,000 CMI + Serious Mental Illness CMI Patients CMI-SMI Patients Patient-Centered Medical Homes Mental Health Clinics • RN Care Managers • Nurse Practitioners • 10 Community Health Workers (1:30 • 134 Community Health Workers patients) (1:15 patients)

Founded in 2000 as a statewide organization, Visión y Compromiso ( VyC ) is dedicated to supporting Promotores as community experts through the Promotoras and Community Health Workers Network (Network), the first statewide association to respond to the support, development, communication and legitimacy concerns of Promotores in California. Because of its unique partnership with over 4,000 Promotores living in both urban and rural areas, VyC has a keen understanding of the social, economic and environmental determinants affecting health in these communities. By integrating Promotores into different aspects of the health care delivery system, VyC aims to increase the capacity to improve health for greater numbers of poor, working poor and un/underinsured communities. VyC utilizes a multi-pronged model to improve opportunities for Promotores that includes: 1) Promotor training and support based on personal and professional development interests and regionally identified needs; 2) Technical assistance to workforce partners to improve the integration of Promotores into diverse industries; and 3) Advocacy for public policies that promote long term, sustainable improvements in health.

Promotores and Community Health Workers • Vision y Compromiso, a California Promotora/Community Health Worker Network • An Esperanza Promotora serving on the 15 member National Steering Committee for Promotores de Salud under the The Office of Minority Health (OMH) of the U.S. Department of Health and Human Services. Promotores in California fear - • mandatory certification will open the field to those who can pass the certification requirements but who do not have the essential qualities or share the primary characteristics and values that are required to be a Promotor. “Just because someone has a degree or ‘those little letters after their name’ does not mean that they can be a Promotor .” • their ideas will be commercialized but their own struggles for recognition and economic benefits will continue.

Activist Model Professional Model Recruit from ranks of community Recruit based on those with college activists, under/unemployed home pre-reqs or previous healthcare health workers and current workforce experience Curriculum developed by SEIU affiliates College curriculum based on DACUM with popular education, political or other academic-based assessment context, and specific competencies Work-based learning with worker Clinical set up by college with area mentors to integrate into new team employers who may not have desirable approaches care models Apprenticeship model where students Students apply for jobs after are employed while studying completion of program Program aligned to supporting Individual career paths for students, transformation to team-based care not aligned to functioning in teams: where non-licensed and credentialed values obtaining a certificate or license are valued equally National certificate from US DOL State, College, or Association granted Apprenticeship Standards Certificate, License or Degree