What can community health workers do for provider organizations and how does your center help with this?
Most of your audience knows who community health workers are and have heard magical stories of trust and getting somebody’s electricity back on. We’ve heard these stories too, but we asked ourselves, “How do you do magic with consistency? How do you set up community health workers for success every time?” That’s what we tried to build with our IMPaCT (Individualized Management for Patient-Centered Targets) model.
It turns out that you have to do a lot of things right in order to achieve that magic. You have to hire the right people who are trustworthy and who have that shared life experience. You need training at all levels—community health workers, their supervisors, the directors. Then you have to solve for the balance between clinical integration. We want community health workers to be a part of care teams, but we also want them to retain that grassroots identity that really defines them.
Then you have to design work practices that allow them to meet patients as people, not checklists. This isn’t a screen-and-refer platform. This is about getting to know people and asking them what they need in order to live their best life and doing those things. And you need infrastructure, supportive supervision, salary, career ladders, and things like that, so we designed IMPaCT as the best practice model to achieve some of that.
What results have you seen?
We’ve tested it now in four randomized control trials across all sorts of patients, different conditions, different settings, inpatient, outpatient, and we’ve seen consistent results. It improves quality of healthcare, HCAHPS, as well as access to care. It improves actual health outcomes—things like chronic disease control, mental health, patient satisfaction. And it reduces hospitalizations by 65%. We recently published a study based on these trial findings that showed the initiative returns $2.47 for every dollar invested by the payer within the fiscal year.
We’re starting to see these replicated in places outside of the Philadelphia region where we first started doing this work. On the basis of some of these results, we are looking at a national scale. We’ve built programs not only in Philadelphia but across 20 states.
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What can CEOs learn from this model?
A lot of times, CEOs may be thinking about community health workers as just purely a service workforce who work with the victims of injustice and inequity. But health inequity is a psychological condition that starts with people who have privilege. Those of us who are privileged, we become susceptible to psychological distortions, whether it’s racism, xenophobia, greed, and those distortions make their way into our policies, which then affect the distribution of power and resources within our institution, or even across society. That affects living conditions, behaviors and health. There’s a chain reaction that ends with the patient, but it starts with leaders. We wanted to ask ourselves, “How can community health workers not only solve for the right-hand side of the equation by coaching people and getting them ride tokens and helping them live their best life, but how can they go all the way upstream and really intervene at the root cause of inequity?”
So Ashley Harris, who’s a community health worker colleague of mine, myself and a couple of other team members designed an executive education experience geared for the C-suite of a healthcare organization. It’s a small-group experience where five C-suite leaders are paired with five community health worker mentors, and there’s a combination of one-to-one sessions in addition to small-group interaction. They get to know each other’s stories. They use that to explore why are our stories so different. Why are the community health workers talking about having been homeless or losing somebody to violence or facing economic hardship? The C-suite is having a really different lived experience. What are these structural forces that shape our lives?
