Community Health Worker Policy and Impact in Public Health

Public Health Academy: Community Health Worker Policy Presented to Public Health Academy Teams 10.22.13 Presented by Buffalo County Public Health Academy Team

A Community Health Worker is a frontline public health A Community Health Worker is a frontline public health worker who is a trusted member of and/or has an unusually worker who is a trusted member of and/or has an unusually close understanding of the community served. This close understanding of the community served. This trusting relationship enables the CHW to serve as a trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services liaison/link/intermediary between health/social services and the community to facilitate access to services and and the community to facilitate access to services and improve the quality and community capacity by increasing improve the quality and community capacity by increasing health knowledge and self health knowledge and self- -efficiency through a range of efficiency through a range of activities such as outreach, community education, informal activities such as outreach, community education, informal counseling, social support and advocacy. counseling, social support and advocacy. - -American Public Health Association American Public Health Association

Job Titles Under CHW Umbrella: Outreach Coordinator Outreach Coordinator Community Liaison Community Liaison Family Advocate Family Advocate

What do Community Health Workers do? Improve health outcomes Increase access to health care Help reduce medical costs

What have Community Health Workers Accomplished? Improved health care outcomes Increased adherence to patients health care goals Lower costs to the health care system, e.g. payers, providers, hospitals, and public

Whats Missing? Nebraska does not have a standardized, reimbursable system to insure a workforce structure for CHW that encompasses core competencies and a scope of practice meets the requirements of the patient centered medical home and medical neighborhoods.

Why does it matter? Reduce the cost of health care in the state Improve health outcomes Decrease health disparities Improve access to health care/ social services

What should be done? Reduce Reduce health costs health costs with with dedicated dedicated workforce workforce Develop Develop standard standard training with training with certification certification Create Create standard core standard core competencies competencies Define scope Define scope of practice of practice Adopt Adopt APHA APHA definition definition of CHW of CHW

Next Steps for Nebraska: Approve Public Policy Recommendation presented to NE CHW Steering Committee Establish and adopt standardization of community health worker training to meet the demands of population health by defining: Recognize and Evaluate CHW workforce CHW Definition Scope of practice Core Certification Standards competencies

Bridging/cultural Bridging/cultural mediation between mediation between communities communities and the health care and the health care systems systems Provide culturally Provide culturally appropriate and appropriate and accessible health accessible health education and education and information information Community Community Organizer Organizer Outreach/ Outreach/ enrollment/ enrollment/ informing agent informing agent Assuring that Assuring that people get the people get the services they need services they need Scope of Scope of Practice Practice Screening and Screening and health education health education provider provider Providing informal Providing informal counseling and counseling and social support social support Advocating for Advocating for individuals and individuals and community needs community needs Navigator Navigator Member Member of care delivery of care delivery team team Provide direct Provide direct services services Build Build individual and individual and community community capacity capacity

Core Competencies Communication Skills Knowledge of specific health issues Interpersonal skills Case Capacity Building Skills Management Organizational Skills Advocacy Skills

Policy Implementation: 1. Nebraska needs to adopt the American Public Health Association s (APHA) definition of Community Health Workers as an umbrella job classification for the varied job descriptions already being used throughout the state of Nebraska. 2. Nebraska needs to adopt a certification training program for Community Health Workers, which includes standardized core competencies and a scope of practice based upon consistent themes found in national research. 3. Nebraska needs to adopt a standardized payer system which incorporates Community Health Workers into the Center for Medicare/Medicaid Services (CMS) and commercial payers. The Community Health Worker should be included as a part of the integrated health care team to help reduce the cost of health care and improve health outcomes.

Further Action Steps to Policy: Nebraska should complete a statewide assessment and evaluation of CHWs and their impact on the health and the health care system. Include CHWs in integrated health care team in both private and public settings.

Projected Impact and Research Reduce health care costs and reduce ER use Improve health and well-being of population Appropriate care at the appropriate time In Buffalo County, Nebraska, Community Health Workers have demonstrated a 5:1 return on investment and cost savings of $3.5 million for the hospital in two years.

Projected Impact and Research Reduce burden on physicians Integrate with health team and community referral system Improve population health In New Mexico, 1% of Medicaid participants were consuming 20% of state support. Community Health Workers reduced the use of resources, resulting in cost savings of over $2 million.

Projected Impact and Research Increase access to health and social service needs Infuse social services and medical needs to provide holistic care Improve the humanity in health care In Arkansas, Community Health Workers helped the elderly population address housing, medical, and social needs to keep them in their own homes rather than assisted living or nursing homes, resulting in cost savings over $2.6 million for tax payers from 2005-2008.

Communication Plan # 1 Prepare Stakeholders # 2 Assist Nebraska CHW Steering Committee Pubic Health Association of NE Nebraska Medical Association Nebraska Hospital Association Physicians / Clinics / Payers Community Action Agencies CHI Nebraska Regional Behavioral Health Unicameral Health Task Force Share Research Share One Page Flyer Participate on work groups

Thank you UNMC! Comments Questions Clarifications Next Steps Buffalo County Public Policy Academy Team: Terry Krohn, Two Rivers Public Health Department Jessie Perez, Buffalo County Community Partners Ann Tvrdik, Region 3 Behavioral Health Services Julie Weir, Community Action Partnership of Mid NE Crystal Winfield, Sentinel Health Care Denise Zwiener, Buffalo County Community Partners Home Team: Dr. Ken Shaffer, Carol Wahl Good Samaritan Hospital