GENERATIONS – Journal of the American Society on Aging

“These [CHWs as] individuals have faced challenges many of us take for granted, such as food insecurity, a lack of transportation, and poor housing,” according to Kenneth Fawcett, M.D., vice president of Spectrum’s Healthier Communities. “Because they are local, too, out- reach workers tend to connect quickly with area residents,” Fawcett adds. A number of CHWs are former Spectrum patients. The Core Health program has produced impressive results in terms of improved health outcomes and a positive return on investment via reduced emergency department visits and inpa- tient admissions. And following a two-year pilot study (2013–2015), Core Health has expanded Some CHWs have faced food insecurity, a lack of transportation, and poor housing. into rural Greenville and Lakeview, north of Grand Rapids. From an original focus on diabe- tes and cardiovascular disease, the program’s focus has expanded to include asthma and chronic obstructive pulmonary disease (COPD). In the rural study, patients receiving at least one CHW home visit per month “had fewer read- missions, lost weight, increased their activity level, improved their blood pressure and even had fewer dentist visits than before; appointment no- show rates have dropped. Total inpatient read- mission charges for diabetes patients dropped by almost 39 percent, while inpatient readmission costs for heart failure patients fell by 9.5 percent, and readmission costs for those with both condi- tions dropped slightly more than 14 percent.” Lower inpatient readmissions alone reduced annual costs by almost half a million dollars. Spectrum has noted further intangible ben- efits from improved relationship quality with patients, and sees the initiative as central to the evolution of more person-centered care. The rural program had a caseload averaging eighty to one hundred patients in 2016, around

twenty-five per CHW; activities include setting and reinforcing the person’s goals, and address- ing social determinants of health, such as hous- ing and food insecurity. Spectrum attributes its success with CHWs to a deliberate change-management process in­ volving all internal and community stakehold- ers, and notes that the rural hospitals’ CHW efforts gained momentum when they became part of Spectrum and were able to leverage the resources and strategic vision of a large inte- grated system. Spectrum also has been an active supporter of the Michigan CHWAlliance (MICHWA) since its inception in 2011 and, since 2003, has organized its own annual educational confer- ence for CHWs. According to ProgramManager Celeste Sánchez Lloyd, Spectrum has provided informal technical assistance to other employer organizations and contributed substantial in- kind staff support to developing MICHWA’s standard CHW core training curriculum (in- person interview with Celeste Sánchez Lloyd, June 22, 2018). A recent experience in Washington State illustrates the challenges of simultaneously introducing multiple policies when trying to transform healthcare. A statewide reform initia- tive, Accountable Communities of Health (ACH) (Spencer, 2018), incorporated a broader mandate to integrate CHWs. At the same time, state agen- cies engaged stakeholders in developing policies affecting the CHWworkforce. Both initiatives called for engaging multiple parties in support of CHWs, and in such situations, role confusion can arise, especially when some parties have limited experience with CHWs. ACHs extend the Accountable Care Organi- zation concept by integrating a wide variety of community partners: housing agencies, school systems, law enforcement, etc., into efforts to address root causes of community health con- Washington Community Health Worker Task Force, Seattle, Washington

38 | Spring 2019

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