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 Susan A. Chapman, Jacqueline Miller, Jennifer Schindel Healthforce Center at UCSF 6/28/2017

Background Community Health Workers (CHWs) play a vital role in the delivery health related services, particularly to vulnerable populations  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 2 6/28/2017

Funding: Blue Shield of California Foundation

Methods  Two phases:  Synthesis of previous work on CHWs  Site visits to a variety of programs utilizing CHWs  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 4 6/28/2017

Challenges with Traditional Workforce Planning for CHWs Traditional workforce planning models center on an approach that includes:  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 plan 2  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. 5 6/28/2017

CHW Data and Sources California Occupational Employment Projections 2012 - 2022 Annual Estimated Projected Numeric Percent SOC Occupatio Average Change Change Employment Employme Code nal Title Percent 2012-2022 2012-2022 2012 nt 2022 Change Community 21- Health 1094 Workers 6,600 7,900 1,300 19.7% 2.0% 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. 6 6/28/2017

Policy Brief Findings Research to date has shown that effective workforce planning support in California could benefit from the following efforts:  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 role 1 1. https://healthforce.ucsf.edu/sites/healthforce.ucsf.edu/files/publication-pdf/BSCF%20CHW%20Policy%20Brief%20Final%201.4.17%5B1%5D.pdf 7 6/28/2017

Site Visit Interviews 5 sites in California  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 8 6/28/2017

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. 6/19/17 9

Site Visit Findings To achieve sustainable employment and integration of the CHW role into health care teams:  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 organizational 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 10 6/28/2017

Theory of Change Framework “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 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 organizations, 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. 6/19/17 11

Backwards Mapping to Long Term Goal 12 6/28/2017

Elevated recognition of the CHW role as a spectrum of job titles Clinical entities with a collective function demonstrate full centered on delivering commitment and person-centered care requirements to across the continuum of directly address community through social determinants clinical settings of health in care delivery models “We are like the thread in the material, you don’t always see it but it’s important. You are always “Doctors and social workers do not go winding and tying things together back into to the community to address from the community to the medical more upstream issues. Narratives [and field.” — Community Health Worker actions] of CHWs are more powerful than what other providers could do. They are the tools for change and advocacy. – Medical Director 13 6/28/2017

Care delivery organizations are fully primed to integrate a patient- centered non-clinical CHW role into coordinated care “ 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 6/19/17 14

CHW model of care is fully respected and established within care delivery models addressing social determinants of health “ 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 6/19/17 15

Provider and payer systems integrate CHW employment into cost of care “ 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 6/19/17 16

ACTIONS: Building the foundation for successful CHW/Promotora integration into clinical care teams 6/19/17 17

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 18 6/28/2017