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California Health Care Foundation and others discuss the value of community health workers and promotores in Medi-Cal – State of Reform

The California Health Care Foundation (CHCF) hosted a webinar last week in which they discussed their newly released online resource center for managed care plans looking to integrate community health workers and promotores into their programs. This resource center was created as part of CHFC’s “Advancing California’s Community Health Worker & Promotor Workforce in Medi-Cal” project. 

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Project contributors and panelists from various organizations took part in the conversation that aimed to inform other organizations, especially managed care plans, about the new resource center, and answer questions from participants about the value and implementation of a community health worker and promotor workforce, as well as the project itself. 

The project was designed to have a very specific impact, according to Carlina Hansen, senior program officer at the CHCF. Ultimately, the intended impact is to help Medi-Cal managed care plans and their partners access strategies and practical tools to integrate effective, evidence-based community health worker and promotor services, with the overarching goal of advancing health equity.

The four high-level topics in the comprehensive resource guide — Developing and Financing CHW/P programs and Partnerships, Establishing Roles and Recruiting CHW/Ps, Training and Supporting CHW/Ps, and Engaging CHW/Ps in Data Collection and Program Outcome Measurement — were designated as critical points to address by a team of more than 30 stakeholder organizations. This stakeholder group conducted meetings throughout the research process and identified information that would be important for a managed care plan to know as it integrated or grew the community health worker and promotor workforce. 

The project team gathered information from all contributors, as well as local and national subject matter experts, and held periods for engagement with local stakeholders, including community health workers and promotores, and repeated this process four times since research began in October 2020.The project team then refined and brought all of this information together into the online resource center and companion downloadable guide. 

In the webinar, senior associate at Health Management Associates and project contributor Nayely Chavez highlighted some key features of the resource center and guide. The resource center includes a curated list of comprehensive tools and resources, including sample job descriptions, training guidelines, program evaluation, and return on investment estimator tools, as well as a program design checklist that managed care plans can use as they develop a new program or refine an existing one to include community health workers.

Hansen stated that the project background is rooted in CHCF’s mission to improve the way the health care delivery system provides care to Californians, especially in low-income and underserved communities.

“We recognize the historical and continued oppression experienced by black, Latinx, Asian, Pacific Islander, indigenous people, and other racial and ethnic groups. That is why we also work to create a health care system that is designed to redress and not perpetuate the inequities that too many of our fellow Californians face. One of the best opportunities that California has to advance that work is to strengthen Medi-Cal, the cornerstone of California’s safety net. Our work in Medi-Cal is focused on getting people covered, making care just, and delivering better care.”

Additionally, the project is based upon research that shows that community health workers and promotores, because of the cultural connections and life experiences they share with the communities they serve, can play a critical role in addressing health disparities. Additionally, managed care plans and providers who work with community health workers and promotores through Medi-Cal consistently achieve improved health outcomes, reduced barriers to care, and show a high return on investment. Shannon Mong, managing consultant at In-Sight Associates and project contributor, stated:

“Their unique connection to the community and their trusting relationships with that community mean that this workforce is very well positioned to mobilize a community to deal with macro issues as we’ve seen so many times during COVID. So, because of this unique skillset, community health workers and promotores are really well positioned to play a key role in providing new CalAIM services to Medi-Cal members, along with other types of high value services.”

Hansen stated that CalAIM’s enhanced care management and an incentivized coordinated approach to caring for high-need patients both present good opportunities to include community health workers and promotores.

Lakshmi Dhanvanthari, M.D., chief medical officer at Health Plan of San Joaquin and project contributor, stated that community health workers need to be incorporated as team members with other health care providers.

“… Looking at the CalAIM initiatives and everything that the Medicaid managed care plans are required to implement, it’s so important to have a complete team, and it’s not just the clinician, but we need someone that can spend a lot of time, that can really relate to the patients, understand their aspects, understand the community where they come from, and the big picture, and not just focus on certain health care questions.”

Dhanvanthari added that a community health worker and promotor workforce could help combat data collection challenges faced by health plans. 

“As a health plan … we’d really like to move beyond the claims and encounter data and get as close to the clinical data as we can, and when the community health workers are involved … they can really help with collecting meaningful data. They can help with the health risk assessments and even at the end of the project if we want to look at the outcomes. Even if it’s a simple questionnaire that they can implement for us, it would give us so much meaningful information about the projects.”

Dhanvanthari also mentioned that this workforce could help bridge the gap between medical and behavioral health information collecting, and combine those two data sources to measure a person’s health more holistically. 

Joseph Calderon, senior community health worker and trainer at Transitions Clinic Network, emphasized his belief in the value of community health workers and promotores for Medi-Cal plans. 

“The CBOs that have community health workers with established relationships in communities is like a 100 yard touchdown without throwing the ball … you’re reaching a community that historically probably hasn’t had insurance, and is very, very, very untrusting of the systems that we live in … They’re already engrossed in and … have those relationships in the community … Being an interpreter from the community to the clinic and clinic to the community is priceless …

When you hire from the community to serve the community, you’re at an advantage. You’re hiring somebody that knows the problem, has defined it in their own life, seen it, worked on it, and now wants to be a part of the solution for the community … I’ve seen clinics nationally really succeed based on who they hire as a CHW.”

The CHCF will be launching their next phase of this project in early 2022. They plan to support four regions in the state that are currently seeking to expand their CHW and promotor workforce through Medi-Cal. 

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