Community Health Workers is to Recruit and Retain Patients - - PowerPoint PPT Presentation

“The purpose of Community Health Workers is to Recruit and Retain Patients”

Something about Los Angeles

• L A Dept of Health Services = Second largest safety net health

system in the nation + LA Dept of Mental Health

• $4 billion budget - ~ $1 billion is provided by LAC general fund
• 24,000 DHS workers, 3,000 DMH workers
• 800,000 patients annually in directly operated facilities
• 2.7 million ambulatory care visits , 280,000 emergency

department, 230,000 urgent care visits, and 75,000 inpatient admissions

• Four nationally-recognized hospitals, academically affiliated with

USC and UCLA Schools of Medicine

• 19 outpatient centers and financially supports 160 community-

based clinics

• Payer mix: 52% uninsured of whom one-third will gain Medicaid in

2014 (many will be ineligible)

• 62% Latino, 13% African-American, 9% White, 6% Asian, 10%
• ther
• 65% of DHS users have a household income < $10,000

• Setting up appointments with their main doctor or nurse practitioner for regular check

ups

• Making sure they get their medicines when they need them
• Following up after a hospitalization or serious illness – staying in contact
• Making sure they get screening tests in a timely manner such as mammograms or

blood work

• Making sure that patients are signed up for a care plan that helps pay for the servicetc.

Integrate – Physical and Mental Health: patient education, care management,

RECOVERY MODEL

• Provide linkage both to physical, mental and substance abuse treatment services, as

well as community supports-

Navigate – Health, not just healthcare – how to eat, live, work in a healthy environment

• Support self – care such as healthy nutrition, exercise programs, manage a chronic

illness

• Community resources for housing problems, environmental concerns, hazards on the

job, domestic or community violence

• Employment issues or legal documentation
• Support groups, education resources, etc.

Core Skill Sets

Coordinate -Consolidate one common wellness/health goal across all service systems

and identify integrated objectives and strategies for enhancing individual outcomes

PATIENT- CENTERED MEDICAL HOME

Enhanced Access - Convenient access to clinical care not only through clinic visits but also via telephone and other modes of communication. Patients will know who their providers are and how to contact them when they need something. Self-Management Support – Learn about the issues that affect the patient’s ability to improve their access to health care such as family and work obligations, transportation barriers. Learn about resources in the community for the patient to improve their health through better nutrition, safety, exercise, improved housing, etc. Patient Tracking – Improve specialty care access and streamline the referral process throughout the system. Performance Feedback – Reduce no-show rates, simplify patient scheduling, reduce wait times, same day appointments – and many

• ther indications that services are improving..

Patient-Centered Integrated Medical Home

Primary Care Team

One Physician or Nurse Practitioner Health Coordinator

1.5 Certified Medical Assistants per provider or Community Health Worker or LVN or other?

0.2 Nurse per provider = Care Giver 0.2 Nurse per provider = Care Manager

0.5 Clerk

Primary Care Provider

Licensed Clinical Social Worker Psychiatrist Substance Abuse Service Provider

CMI Patients Patient-Centered Medical Homes

• RN Care Managers
• 10 Community Health Workers (1:30

patients) CMI-SMI Patients Mental Health Clinics

• Nurse Practitioners
• 134 Community Health Workers

(1:15 patients) Harbor-UCLA Medical Center Acute Care Assessment Team

• Nurse Practitioner (NP)
• Psychiatric Social

Worker Olive View Medical Center Acute Care Assessment Team

• Nurse Practitioner
• Psychiatric Social

Worker

Los Angeles County DHS Care Model

LAC+USC Medical Center Acute Care Assessment Team

• Nurse Practitioner
• Psychiatric Social

Worker 300 Chronic Medical Illness Patients (CMI) 2,000 CMI + Serious Mental Illness

Founded in 2000 as a statewide organization, Visión y Compromiso (VyC) is dedicated to supporting Promotores as community experts through the Promotoras and Community Health Workers Network (Network), the first statewide association to respond to the support, development, communication and legitimacy concerns of Promotores in California. Because of its unique partnership with over 4,000 Promotores living in both urban and rural areas, VyC has a keen understanding of the social, economic and environmental determinants affecting health in these communities. By integrating Promotores into different aspects of the health care delivery system, VyC aims to increase the capacity to improve health for greater numbers of poor, working poor and un/underinsured communities. VyC utilizes a multi-pronged model to improve opportunities for Promotores that includes: 1) Promotor training and support based on personal and professional development interests and regionally identified needs; 2) Technical assistance to workforce partners to improve the integration of Promotores into diverse industries; and 3) Advocacy for public policies that promote long term, sustainable improvements in health.

Promotores in California fear -

• mandatory certification will open the field to those who can pass the certification

requirements but who do not have the essential qualities or share the primary characteristics and values that are required to be a Promotor. “Just because someone has a degree or ‘those little letters after their name’ does not mean that they can be a Promotor.”

• their ideas will be commercialized but their own struggles for recognition and economic

benefits will continue.

Promotores and Community Health Workers

• Vision y Compromiso, a California Promotora/Community Health Worker Network
• An Esperanza Promotora serving on the 15 member National Steering Committee for

Promotores de Salud under the The Office of Minority Health (OMH) of the U.S. Department

• f Health and Human Services.

Activist Model Professional Model Recruit from ranks of community activists, under/unemployed home health workers and current workforce Recruit based on those with college pre-reqs or previous healthcare experience Curriculum developed by SEIU affiliates with popular education, political context, and specific competencies College curriculum based on DACUM

• r other academic-based assessment

Work-based learning with worker mentors to integrate into new team approaches Clinical set up by college with area employers who may not have desirable care models Apprenticeship model where students are employed while studying Students apply for jobs after completion of program Program aligned to supporting transformation to team-based care where non-licensed and credentialed are valued equally Individual career paths for students, not aligned to functioning in teams: values obtaining a certificate or license National certificate from US DOL Apprenticeship Standards State, College, or Association granted Certificate, License or Degree