Disclosure. Today s presenters do not have any relevant financial interests presenting a conflict of interest to disclose.

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2 Disclosure Today s presenters do not have any relevant financial interests presenting a conflict of interest to disclose. Participants must attend the entire session(s) in order to earn contact hour credit. Continuing Nursing Education credit can be earned by completing the online session evaluation. The American Organization of Nurse Executives is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. AONE is authorized to award one hour of pre-approved ACHE Qualified Education credit (non-ache) for this program toward advancement, or recertification in the American College of Healthcare Executives.

3 Objectives 1) Describe the value of community health care workers as part of the mainstream health care system in a manner that will effectively communicate the importance of these programs to hospital executives and board members. 2) Describe how to integrate and implement a community health worker program into a hospital or healthcare system in a cost effective manner. 3) Apply tools and resources to aid in implementation of a Community Health Worker Program in any healthcare setting. Building a Community Health Worker Program 3

4 RWJF Executive Nurse Fellows Loraine Frank-Lightfoot, DNP, MBA, RN, NEA-BC Beth A. Brooks, PhD, RN, FACHE Sheila Davis, DNP, ANP, FAAN Pamela A. Kulbok, DNSc, RN, PHCNS-BC, FAAN Shawanda Poree, MBA, BSN, RN Lisa Sgarlata, MSN, MS, RN, FACHE. Building a Community Health Worker Program 4

5 THE CHW ROLE: Why Now?

6 History and Background As the demand for care increases, so will the role of community health workers Building a Community Health Worker Program 6

7 Twenty percent of the people in the U.S. have inadequate or no access to primary care. The healthcare system in the United States is undergoing a monumental transformation. Escalating costs have limited the public s ability to access affordable, high-quality health and medical care. With the implementation of the Patient Protection and Affordable Care Act (U.S. House of Representatives, 2010), commonly called the Affordable Care Act (ACA), healthcare insurance coverage will expand to an estimated 32 million people by 2014, with millions more to follow in the years to come. Obviously there is a need for novel approaches to provide access to primary care approaches that will help hospitals and health systems to decrease readmissions and emergency department visits; increase patient adherence; improve health and wellness; reduce risk; prevent disease; and meet population needs identified by ACA-mandated Community Health Needs Assessments. Building a Community Health Worker Program 7

8 CHW Interventions Produce Cost Savings Building a Community Health Worker Program 8

9 FORMULATING THE CHW ROLE

10 CHW ROLE History of the role Global USA Definitions of the role ACA, APHA, WHO,BOL, HRSA Uni-modal vs. Polyvalent CHW compared to other roles CNA, MA, HHA Building a Community Health Worker Program 10

11 The ACA defines community health worker as an individual who promotes health or nutrition within the community in which the individual resides. Per the Act, a CHW promotes health in the following ways: By serving as a liaison between communities and healthcare agencies By providing guidance and social assistance to community residents By enhancing community residents ability to effectively communicate with healthcare providers By providing culturally and linguistically appropriate health or nutrition education By advocating for individual and community health By providing referral and follow-up services or otherwise coordinating care By proactively identifying and enrolling eligible individuals in federal, state, local, private, or nonprofit health and human services programs

12 A Widely Accepted and Recognized Concept

13 FORMULATING THE ROLE Education Type, setting Performance Management Tools, Job Aids Workload Catchment area Outcomes Triple Aim Building a Community Health Worker Program 13

14 STRATEGIC STAKEHOLDERS

15 STRATEGIC STAKEHOLDERS External Community agencies Internal Senior leadership Medical staff Care team members Talking Points Tailor the message Building a Community Health Worker Program 15

16 IMPLEMENTATION CONSIDERATIONS

17 Implementation Best Practice What drives developing a CHW program? What size and scope does my community need? Program management Who is involved? Who runs the program? How to supervise? What tools are needed? Building a Community Health Worker Program 17

18 Implementation Best Practices Education of existing staff Monitor effectiveness Liability and safety issues The business case Building a Community Health Worker Program 18

19 Implementation Best Practices Elements of successful programs: Recruitment The CHW Role Training Initial Ongoing Equipment and Supplies Supervision Evaluation Building a Community Health Worker Program 19

20 Implementation Best Practices Elements of Successful Programs (cont.) Incentives Community Involvement Referral System Opportunity for Advancement Documentation & Information Management Linkages to Health Systems Program Performance Evaluation Building a Community Health Worker Program 20

21 Implementation Best Practices Patient Sources Building a Community Health Worker Program 21

22 CASE STUDIES WOOSTER COMMUNITY HOSPTIAL & PARKVIEW REGIONAL MEDICAL CENTER & AFFILIATES

23 Wooster Community Hospital

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25 Who we are Open / Staffed Beds 6,100 Admissions 1,100 Births 33,000 ED Visits 1,000 Employees Payroll - $38 million Net Revenue: $107 million

26 Program Inception Opportunity to address: Readmission issues Complex patients Community Need Physician (unrecognized) need Opportunity for: Partnership with local college Increased positive community perception The right thing to do Building a Community Health Worker Program 26

27 The Program A Partnership Wooster Community Hospital & College of Wooster Building a Community Health Worker Program 27

28 Program Components: Students as Health Coaches Student Selection Student Preparation / Education Semester long course Shadowing CPR Clinical Competency Assessment Building a Community Health Worker Program 28

29 Program Components: Participants & Process Patient Referrals & Enrollment Detailed Assessment Motivational Interviewing Comprehensive Care Plan Intervention Evaluation *Primary Care Physician Building a Community Health Worker Program 29

30 Wooster Community Hospital CCN Screening and Patient Identification Identification Sources: CCN Date Review Practitioner Identification Community Referral In-Patient Screening Identification Start Screening Site: Hospital Patient s Home Practitioner s Office Data Review Chronic Diagnosis Other Diagnosis Screen (refer to diagram below) Review patient s Healthcare Utilization If > 2 hospitalizations or ED visits in last 6 months OR If history of chronic medical problem Screened ye s n o No Utilization Not Screened Screening Program introduction and Overview Program interest expressed Decline screening Risk tool performed No further action END No needs Needs identified Obtained consent No further action Consent signed Refused Complete CCN Care Plan and notify PCP of enrollment in program Offer Follow-Up phone call

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32 Building a Community Health Worker Program 32

33 Program Components: Tools Building a Community Health Worker Program 33

34 Program Components: Tools Building a Community Health Worker Program 34

35 Care Plan Building a Community Health Worker Program 35

36 Disease Specific Care Plan Building a Community Health Worker Program 36

37 Program Components: Staff Program Director: 1 FTE Physician Medical Directors: LPN: 1.5 FTE Social Worker: 0.5 FTE Dietician, Pharmacist, Therapist: PRN Health Coaches Building a Community Health Worker Program 37

38 Program Components: Evaluation Data collection Results Building a Community Health Worker Program 38

39 Results 54% Reduction in Admissions 26% Decrease in use of the ED 100% Compliance with correct medication use (med boxes) Smoking cessation HgA1C goal achievement BP goal achievement 100% Building a Community Health Worker Program 39

40 CASE STUDIES WOOSTER COMMUNITY HOSPTIAL & PARKVIEW REGIONAL MEDICAL CENTER & AFFILIATES

41 Parkview Health Building a Community Health Worker Program 41

42 Parkview Regional Medical Center & Affiliates

43 Who we are... Open / Staffed Beds: 807 Discharges: 41,927 Births: 4,444 ED Visits: 168,093 Employees: 9,002 Payroll - $623 million Net Revenue (Operations): $1.35 billion

44 Care Continuum Community Nursing School Nurses Community Agencies Aging & In-home Services Discharge Clinics Home Healthcare & Hospice EMS House Calls Tele Health Nursing Homes Extended Care Mobile Care Building a Community Health Worker Program 44

45 Where Do CHWs Fit? Care Advisors & Transitional Care Nurses Physician Practice Based? Hospital Based? Home Health Based? Paramedic? Qualifications? Students? Elective College Course Building a Community Health Worker Program 45

46 Key Recommendations & Take-Aways Clear expectations & outcomes Student vs. patient focus Budget for equipment Medication Boxes: $300 purchase & $20 / mo. software Tele-health Units: $2,500 purchase & $60 / mo. software Clear patient outcomes What do we want to accomplish? Feedback patients and CHWs Administrative support Clear roles & job descriptions Building a Community Health Worker Program 46

47 Building a Community Health Worker Program 47

48 Questions and Resources

49 CHW GUIDEBOOK AONE Webpage: Building a Community Health Worker Program 49

50 Contact Us Loraine Frank-Lightfoot or Beth Brooks Building a Community Health Worker Program 50

51 Special Thanks Alex Davis Wooster Community Hospital Manager, Community Care Network Building a Community Health Worker Program 51