Community health workers help patients implement lifestyle changes
Monday, April 27, 2020
Connecting clinic to community
Medical treatment may occur within hospital walls, but a person’s health journey extends far beyond doctor’s office doors.
Community health workers serve as a bridge between healthcare providers and community resources by helping people address issues adversely impacting their health, said Dr. Deanna Hildebrand, Oklahoma State University nutritional sciences professor. Hildebrand and other OSU leaders organized the Community Health Workers Forum March 12 to discuss how the relatively uncommon healthcare position can be better supported in Oklahoma.
“Community health workers contribute to improved health outcomes in both clinical and public health arenas,” Hildebrand said. “The goal of the forum was to increase awareness and understanding of how community health workers fit into the healthcare system.”
A diverse audience ranging from hospital administrators to policy makers and community health workers gathered to discuss four key topics: integration into healthcare teams, training and certification, policy, and sustainable funding.
“The majority of the day was spent increasing understanding and awareness,” Hildebrand said. “But we also had roundtable discussions. What we heard is that we need to continue talking to different stakeholders and sectors of the healthcare and public health system.”
Meeting a need
Stephanie U’Ren, Director of the Center for Chronic Disease Prevention and Health Promotion with the Oklahoma State Department of Health, said while community health workers are uncommon in Oklahoma, she believes Oklahoma is a prime location for them.
“The vast majority of our state is in a designated healthcare shortage area,” U’Ren said. “And when we think about the social determinants of health, which can influence 80 percent of health outcomes in comparison to genetics and biology, community health workers become even more important.”
Rural areas may be especially underserved, with some counties having no health provider at all, U’Ren added. Yet, as many Oklahomans must travel long distances for medical procedures, they live in a state with high rates of alcohol consumption, obesity and tobacco use – all factors for chronic disease.
Incorporating community health workers into the U.S. healthcare system is not without challenges. Hildebrand said without a training or certification program, care may not be uniform. Additionally, funds are often short.
Dr. Mark Woodring, Assistant Dean at the OSU Center for Rural Health, works with hospital administrators and other healthcare leaders daily to support rural communities’ needs.
“From a rural hospital and clinic perspective, they already have many economic headwinds facing them in terms of provider reimbursement that is often low,” Woodring said. “It’s a position that can certainly improve health, but a key question for them is, ‘How is it funded?’”
U’Ren said she sees an opportunity as some insurance companies adopt value-based care, a new form of medical reimbursement, targeting health outcomes rather than volume of treatment. Since community health workers can improve outcomes, they may one day be covered by insurance. Hildebrand added a bill, recently passed by the Oklahoma House of Representatives, defines the role and certification process of community health workers. If signed by the Governor, the legislation builds a foundation for future efforts in establishing funding sources for services provided by community health workers.
Woodring added another challenge in helping community health workers integrate into the U.S. healthcare system is buy-in from healthcare professionals.
“We often hear concern community health workers are going to take away from healthcare providers,” Woodring said. “One of the key things for everyone to remember is a community healthcare worker is a critical member of team-based care."
U’Ren says rather than replacing medical professionals, community health workers will augment medical professionals’ work. Providing community health workers to a small number of patients with significant medical needs may provide them valuable support while freeing doctors to see other patients.
Hildebrand believes the dialogue fostered at the Community Health Workers Forum will prepare medical and public health professionals and leaders to tackle these challenges.
Such benefits include a 4-to-1 return on investment, Hildebrand said, as every dollar spent on supporting community health workers helps lower patients’ recidivism in the healthcare system. Additionally, hiring skilled employees in small communities can boost economic development.“We need to continue with increasing awareness and understanding to be able to get some policy in place,” Hildebrand said. “We’re going to have to talk the language of stakeholders, speaking in terms of the benefits.”
Woodring sees telemedicine, grant funding for critical access hospitals, and rural rotations for medical students as important components for building the healthcare infrastructure, especially in rural areas. However, even with these diverse tools, community health workers serve a unique niche.
“Community health workers can help address patient issues such as housing, healthy food, access to prescriptions or even violence and the opioid epidemic,” Woodring said. “More people are beginning to realize health is impacted outside the walls of our hospitals and clinics versus inside. And importantly, community health workers most often have very strong ties to the communities and patients that they serve.”
And as community health workers meet diverse needs, Hildebrand believes they will be supported by the diverse stakeholders who attended the Community Health Workers Forum.
“We had physicians represented, we had policy makers represented,” Hildebrand said. “We had a person from the governor’s office there and career tech people there. For them to hear from community health workers what’s needed, I think helped build that bigger picture idea.”
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