Friday, April 25, 2014

Hiring a Community Health Worker

I have written before about the shrinking staffs and budgets of local health departments.  The National Association of City and County Health Officials (NACHO) has published a sobering assessment of the state of the nation’s local public health system which documents layoffs, cutbacks and reductions in programming across the country.    Some local health departments have decided that the verdict from voters and legislators is clear: they do not value public health services.  These departments have reduced their programming to no more the minimum required by law. Other health departments are trying to find new ways to support preventive services in their communities.  Recognizing that funding from local, state and federal taxes will continue to decline, they are becoming social entrepreneurs, trying to identify who benefits financially from preventive services and entering into business agreements with them to sustain these services.

In Michigan, these ideas are part of the State’s plan for improving community health called the State Innovation Model (SIM). The SIM is comprehensive and contains many moving parts, but one piece of it focuses on what are called Community HUBs.  These HUBs may or may not be connected to local health departments, but they share one feature in that they deploy Community Health Workers (CHWs) who work with health care providers to ensure that the sickest and most vulnerable among us get access to preventive care.  CHWs do this by de-duplicating care plans and services and ensuring that clients get all the services to which they are referred, and they follow up to ensure compliance.

HUBs are not supposed to duplicate the care coordination efforts many health care providers are undertaking now.  They are supposed to step in where those efforts fail, with people who fall between the cracks in the health care system—people who frequently and inappropriately use emergency rooms, people with chronic mental health problems that are not under control, etc.

Obviously, there are groups who could benefit from the work of CHWs.  If CHWs are successful in getting people to use emergency rooms more appropriately, health plans would have to pay less for those patients.  And if those people become healthier, physicians and health care systems trying to achieve pay-for-performance goals stand to make more money.

The Mid-Michigan District Health Department has taken one tiny step in this direction.  We have hired our first Community Health Worker!  This person will be working with residents of Clinton County through a HUB located in Lansing.  We are nervous about it, because the HUB doesn’t have any contracts with health plans or hospitals yet.  It is still coasting on grant dollars.  However, we have spoken to some of the plans to find out what their attitude is.  They tell us they love what the Ingham HUB does for their patients and are anxious to see evidence that money has been saved so they can justify signing contracts.

In my opinion, CHWs should not primarily be based in health departments, but should be located in any provider of preventive health services who needs to increase their capacity.  CHWs could help all kinds of community-based organizations improve outcomes for their clients, whether they be substance abuse prevention coalitions, United Ways, mental health providers, etc.

This is an exciting and important experiment.  CHWs could potentially open up a new model for sustaining preventive services and reverse the fraying of the safety net. In five years will human service agencies in Mid-Michigan have a complement of CHWs out in the community?  I hope so.

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