Melissa Mayer

In the process of transitioning to patient-centered medical homes (PCMH), many medical practices are finding that community health workers (CHWs) have a valuable role to play in achieving the aims of this service delivery model. In the South Bronx, New York, one medical practice documented the successful integration of CHWs into the PCMH model. The findings, presented here, shed light on the specific roles of CHWs within a health care team and how CHWs fit within the division of care in a PCMH.

Getting the staff on board

In this case study, the managers of the CHW program took an active role in building institutional support for CHW integration. Although there are different models for linking CHWs to primary care, the goal of this particular practice was the full integration of CHWs into the health care team. With this objective in mind, managers created opportunities for clinical staff to learn about CHW roles; through Continuing Medical Education courses, rounds with CHWs, team meetings and all-staff meetings. The authors cite the involvement in monthly clinical team meetings as a key to integrate CHWs into clinical teams. CHWs may fill a broad range of roles, so defining and communicating these roles to staff and management is necessary to promote understanding of how CHWs fit into the care team.

Building staff support is a key step in the successful integration of CHWs into the health care team. One way to make this case is to demonstrate how CHWs improve the patient-centeredness of care. According to the report, CHWs “present detailed patient care narratives focusing on cultural, social, and communication issues”. They can transform the way that health care team members view patients by correcting misunderstandings and providing context for patient behaviors. Health care providers value the ability of CHWs to connect with patients, overcoming the linguistic, cultural, economic, and other barriers that they are unable to transcend.

Choosing the right people to serve as CHWs

Securing the backing of the human resources department was an important factor behind the success of this initiative. By recruiting qualified candidates based on a well-articulated job description and ideal qualities (in this case, “empathic, natural helper, communicator, and experienced in the community culture”), HR helped choose the right people to serve as CHWs. An intentional selection process helps dispel the myth that anyone can be a CHW and build institutional support by demonstrating their effectiveness. Because some qualities are hard to select for, the Bronx initiative required a probationary period of three months to ensure that hired CHWs are a good fit for the program.

Publicize benefits early and often

Initial reports on cost savings were useful in the bid for institutional support. According to the article, “early evidence of the benefits of the CHWs was critical to obtaining organizational, administrative, and team-wide support”. For every dollar invested in the CHW program, the hospital saved $2.30. Publicizing this impressive outcome among administrators and hospital staff helped build support for the CHW program. These improvements helped the clinic attain the additional $250 per member per month enhanced reimbursement rate for care coordination.

Monitoring and Evaluation

Another important part of this initiative is its focus on monitoring and data reporting. The CHW manager monitors and reviews CHWs through weekly time sheets (Figure 1). Additionally, tracking service utilization rates (i.e. hospitalizations and urgent care visits) has allowed the practice to demonstrate substantial improvements. For example, the rate of hospitalization for patients with chronic disease has declined by 12.6% since CHW integration. The practice also reports qualitative evidence of the program’s effectiveness through patient narratives and patient feedback collected from focus group discussions.

Final Thoughts

Although integrated CHW programs can vary widely, there is much to learn from the Bronx program. The incorporation of CHWs into the care team allowed for the team to better engage patients who experienced the greatest barriers to care. Through full integration with the care team, CHWs helped identify ways in which the care team could become more patient-centered. Thus, it was not simply the addition of the CHW, but the transformative nature of the collaboration between CHWs and other members of the care team, that allowed this practice to improve its outcomes for the most vulnerable patients.

Reference

Findley, S., Matos, S., Hicks, A., Chang, J., & Reich, D. (2014). Community Health Worker Integration Into the Health Care Team Accomplishes the Triple Aim in a Patient-Centered Medical Home: A Bronx Tale. The Journal of ambulatory care management, 37(1), 82-91.