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February 08, 2022 05:00 AM

Q&A with Dr. Shreya Kangovi of Penn Medicine: ‘Being a community health worker is a profession, and it’s a really important one’

Modern Healthcare
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    Dr. Shreya Kangovi

    Dr. Shreya Kangovi is the founding executive director of the Penn Center for Community Health Workers and an associate professor at the University of Pennsylvania Perelman School of Medicine.

    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?

    “How are we unknowingly
    or maybe knowingly
    perpetuating systems that
    benefit some people while
    they oppress others?”

    And then it’s discussing the psychology of racism and injustice. How are we unknowingly or maybe knowingly perpetuating systems that benefit some people while they oppress others? And then how can we translate that to what’s going on in our organizations today and how can we redesign explicitly with a lens toward equity? The community health worker is a coach and a mentor to the execs throughout that whole journey.

    How do we develop community health workers as a profession?

    It’s always nice, over the past 10 years, when folks know who community health workers are, acknowledge them, bring them into the care team, and then it’s kind of a bonus where it’s like, we need to be thinking about career ladders for community health workers. That’s all exciting and great, but my colleagues and I have noticed that a lot of times that kind of conversation means, well, we need to make sure that if a community health worker wants to be a nurse or a social worker that they have a career path to do so. I find that condescending. It just speaks to how we are de-legitimizing certain professions. Being a community health worker is a profession, and it’s a really important one. And there’s so much sophistication, wisdom and leadership in this profession. This is not a service workforce alone. Not that there’s any problem with that, but this is a leadership workforce.

    A couple of colleagues and I recently published a paper after we held focus groups with community health workers to ask them, “What do you want in your career development? What do you want in a career ladder? What would make you happy at work?” And a lot of them said, “I want to do this type of work. I’m not looking to be a nurse. I wouldn’t have become a community health worker if I wanted to be a nurse.” They want to be able to be promoted, i.e., make more money and grow in their profession, but it’s not that they want an exit to something clinical. We’ve designed that within Penn and I think that’s really exciting. That’s where we need to make sure that the field is allowed to grow. The payment is a whole other question.

    Related Article
    The Check Up: Dr. Shreya Kangovi of Penn Medicine
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