Community Health Workers in Florida (June 2011)

Community Health Workers in Florida:Reflecting on the Past; Gaining

Momentum for the Future

Leda M. Perez, Vice President, Health Initiatives

Collins Center for Public Policy

Keynote Address, Community Health Worker Enhancement Task Force

Florida Department of Health

Tallahassee, Florida

June 2, 2011

Looking Back…

• Filled a national void to find best practices and policy alternatives for health care. Community Health Workers became part of the work of every project site.

• CHWs are:

Community Voices: Healthcare for the Underserved National Initiative (W.K. Kellogg Foundation, 1998 – 2008)

Known by different names in different communities i.e., natural helpers, promotoras, doulas, outreach workers, “natural researchers”

Public health workers on the frontlines Trusted members of the communities they serve Bridge-builders between communities and social and/or health serving

organizations

Most of all, CHWs are agents for change – individual and community change – on numerous levels

Agents for Change:National and Local Examples

• Madrinas y Padrinos – East Little Havana

• Adaptation of Trujillo, Peru model• State of the art in South Florida – 2002• CHW working group• Pilot curriculum: English, Spanish and

Haitian Creole in 2004-05• CHW Curriculum-building and

Stakeholder Groups• Basic Level I Curriculum; Adapted

Florida Family Development Credential for college credit at Miami-Dade College

• CHW Network – connections to National Association of CHWs

• National examples: New York, Denver, Baltimore• Community Voices Miami

Lessons from the Past:Community Voices National Initiative

• CHWs are often part of the same vulnerable communities they serve. Recognition and payment are critical.

• The evidence of the work must be continually raised in both state and national policy circles – without buy-in and financing there is no sustainability.

• Every situation is different.

• CHWs have a unique ability to fill the specific needs of their communities and address the health and social issues of our time (e.g., men’s health, prison reentry, language/cultural issues)

Lessons from the Past:Community Voices Miami

• Make time for community buy-in, e.g., any training of CHWs should include system supervisors as well.

• While one provider was able to increase pay for its CHWs, most others struggled. More must be done to bring resources to bear.

• Curriculum-building takes A LOT of time. Demand must be established.

• More evidence was required to provide their efficacy.

Present National Context

• Chronic disease: need for prevention and management

• Managing care for people with special and complex needs

Health Care Systems Challenges

Multiple chronic conditions Mental health and/or substance use Multiple social and economic challenges

Present Context in Florida

• More than 4 million uninsured

• Higher than average unemployment

• High numbers of incarcerated people

• Highly distressed neighborhoods – both urban and rural

But, remember what I said before?

CHWs have a unique ability to fill the specific needs of their communities and address some of the most pressing health and social issues of our time.

CHWs are agents for change!

Opportunity Rings?

• Coverage expansionNational Health Care Reform

• High need for outreach, connection to services, navigation, preventative health care practices

• Document the needs; showcase the evidence of improved health outcomes

Florida Medicaid Reform (?)

• Redesign of how care is delivered

• Cost containment

Accountable Care Organizations, Health Homes

Community-based prevention and management

Payment models focused on value NOT volume

Now: What is to be done?

• Understand state’s geographic and racial and ethnic diversity (i.e., immigrants, vulnerable communities, high rates of formerly incarcerated people, high rates of mental illness/substance abuse

• Present political/legislative environment

Needs assessment for Florida

• Raise this work to new levels, i.e., mobile and telehealth technologies, ACOs, health teams

• Work with colleges and providers to provide training, standardization

• Stakeholder analyses

Opportunity mapping

Now: What is to be done?

• Continue to highlight importance and recognition

• Move toward standardization (with caution)

• Establish a sustainable financing mechanism for the workforce

• Include this worker as part of the integrated system of care

• Develop a diverse health care work force

• Continue a health equity focus – remember Florida’s commitment to improve disparities

In Conclusion…

• CHWs are• As “old as the hills…” Wherever communities exist, they exist• They can and do make a difference in both individual and

community health outcomes

• Continue to gather evidence• These are public policy decisions• Show the efficiency and cost savings• Show the models -- both national and

international -- in preventative health and improved health outcome (e.g., Haiti and acompaneteurs, US/CDC work in heart disease, etc.)

In Conclusion…

• Make new observations and partnerships

• Connect CHWs to technology – electronic medical records, mobile health, etc.

• Showcase this work and its different applications (e.g., as connectors for those returning to community from jail or prison, cost-savings to avoid recidivism; helping people recoup Medicaid benefits upon release, or “community development ombudsmen,” eyes and ears for community needs)

• Work with other systems of care, i.e., education, corrections, etc.

Remember! CHWs are agents for change and they are on the front lines…

Upstream workersat the top of the river,

telling us what is wrong, giving us some clues

for how to fix it…AGENTS FOR CHANGE

The results for our tenacity?

• Increased access & quality of services• Improve health outcomes, especially for

chronic conditions• Reduction/elimination of health inequities• Increased social capital and community

connectedness• Lowered health care delivery costs:

• Fewer resource-intensive ER visits

• Fewer hospitalizations

• Increased use of prevention and primary care

Thank you.For more information on our work:

http://www.collinscenter.org

Contact information:

Leda Perez: [email protected]

305-377-4484, ext. 1529 or 305-767-4632