HJBR Nov/Dec 2022

COMMUNITY HEALTH WORKER PROGRAMS 24 NOV / DEC 2022 I  HEALTHCARE JOURNAL OF BATON ROUGE   medical officer for Humana Healthy Hori- zons in Louisiana, said the CHW funding “will link families to resources such as por- table cribs, birthing education and sup- port, and care during and after pregnancy to ensure mothers and babies begin life with the tools needed for best health outcomes.” Likewise, UnitedHealthcare pointed to investments it has made to help Federally Qualified Health Centers hire additional CHWs. The company also mentioned a spe- cific focus onmaternal health. “We are plan- ning to enhance maternity-specific training for CHWs, which will include home visits.” Louisiana Healthcare Connections said the use of CHWs in its care management program helped the organization achieve a “40.4 percent disparity reduction in timeli- ness of prenatal care, and the elimination of the disparity for postpartum care rates for Black enrollees compared to White enroll- ees from 2019 to 2020.” Veronica Gillispie-Bell, MD, medical director of Louisiana’s Perinatal Collab- orative and Pregnancy Associated Mortal- ity Review, agreed that CHWs “have a huge role to play” in helping to reduce the lead- ing causes of pregnancy-associated deaths, including accidental overdose, motor vehi- cle crash, and homicide. “Because CHWs visit with patients in their community, they are able to acknowledge and address social factors that are impacting health outcomes,” she added. “CHWs can identify substance use dis- order just from talking and working with people, and they can also recognize intimate partner violence,”said CHWCatherine Gray Haywood, who leads the Louisiana Commu- nity Health Outreach Network. Multiple studies report that scalable, evi- dence-based CHW programs can improve lives while reducing costs. A2020 random- ized controlled trial by Shreya Kangovi, MD, with the University of Pennsylvania found “that every dollar invested would return $2.47 to an average Medicaid payer within the fiscal year.”Another randomized clinical trial by the same author found that patients who worked with a CHW before and after hospital discharge had greater completion of primary care follow-up visits, greater medication adherence, lower readmis- sion rates, and greater satisfaction with discharge communication and their own mental and physical health. In a separate randomized clinical trial that focused on patients with multiple chronic conditions who set disease management goals, Kangovi found that patients who also worked with a CHW for six months had better chronic dis- ease control and lower hospitalizations one year after enrollment in the study. A separate analysis by CMS Innovation Center searched for total cost of care reduc- tions in a variety of ambulatory care inno- vations and reported that CHW innovations were the only ones “found to lower total costs (by $138 per beneficiary per quarter).” Responding to these findings, Cole said, “the best way to reduce medical expendi- tures is to improve health. It’s just that sim- ple.” He said he expects reliance on clini- cally-embedded CHWs to further expand as health insurance companies continue mov- ing beyond “traditional fee-for-service for just clinical care” to support future health- care delivery models that focus on “improv- ing health outcomes and total cost of care.” “The more we invest early on, the less likely we are to spend more later, and not only that, we increase the quality of life for these individuals,”said Sen. Regina Barrow, who authored a Senate concurrent resolu- tion to support the expansion of the CHW workforce in Louisiana. Wennerstrom also referenced the broader value CHWs can provide beyond cost sav- ings. “In the course of helping someone manage their diabetes, a CHW might dis- cover that a person wants additional edu- cation and help them enroll in a GED pro- gram,” she said. “That person may then go on to get a better job, which could allow them to obtain health insurance, afford bet- ter housing, and even help pay for their kids to go to college. None of those long-term positive effects would be captured in a tra- ditional ROI model.” n C.J. Marbley Chief Nursing Officer New Orleans East Hospital Alison Glendenning-Napoli Assistant Vice President of Outpatient Case Management Ochsner Health Kenny Cole, MD Vice President of Clinical Improvement Ochsner Health System Veronica Gillispie-Bell, MD Medical Director Louisiana’s Perinatal Collaborative and Pregnancy Associated Mortality Review