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Thursday, August 27, 2015

How Michigan Is Working to Improve Patient Outcomes outside the Clinic

Kara Nester

Policy Analyst

Across the country, states are experimenting with new health delivery models aimed at strengthening primary care and addressing social service needs that can affect a patient’s overall health. Both community health workers and enrollment assisters can serve an important role in this work by connecting clients with services that enable them to obtain care and manage their health.

Community health workers are funded through Michigan’s state innovation model grant

As our health care system embraces the value of quality care over quantity of services delivered, many payers and providers are looking at innovative ways to deliver and pay for health care. The Michigan Primary Care Association (MPCA) is starting to implement a community health worker model in health centers across the state. This unique pilot program focuses on the consumer’s needs as a whole by linking community care with clinical support. 

MPCA envisions the work of enrollment assisters complementing the community health workers’ continuing efforts. The goal is for the consumer to receive assistance through the process of enrolling in health insurance and beyond—as their health needs progress.

MPCA’s model program, Linking Clinical Care with Community Resources, or “Linkages,” places 30 community health workers into primary care teams in 16 health centers across the state. 

Community health workers (CHWs) are trusted members of the community who have a comprehensive understanding of that community’s needs and the health and social services available.

Improving health may require other forms of assistance

MPCA surveyed its clients and found that, in addition to health care, their clients’ top needs include housing, transportation, and food. CHWs can connect clients to these resources and identify ways to improve patient outcomes that extend outside the clinic and into the community.

CHWs are part of Michigan’s state innovation model grant, or SIM grant, which is funded by the Affordable Care Act and aims to transform state health care systems through payment reform and delivery transformation. Learn more: Understanding the SIM initiative.

Community health workers offer creative approaches for helping to meet complex care needs

Community health workers can contribute to improving patient outcomes and overall health outside the clinic setting. For example, the MPCA treated an elderly gentleman who was considered “noncompliant” by his medical professionals. Joe, as we’ll call him, failed to take his medications, and his providers could not figure out why. The MPCA introduced a CHW to the care team, who conducted several site visits to Joe’s home. The CHW discovered that Joe was living with his grandson, who was stealing his medications. The CHW was able to identify and correct this problem through home visits.

The Linkages project’s long-term goals include integrating CHWs as a sustainable member of the care team who can deliver non-traditional, community health services to help meet the complex needs of the population. Like other members of the care team, the CHW would be reimbursed for providing these health services. 

Michigan’s pilot program offers support for patients and relief to providers 

A local community college and the Institute for Population Health are currently training MPCA’s community health workers before the CHWs dive deeper into their work. Here are some highlights from the pilot program so far: 

  • Each health center chose a specific population for the CHWs to focus on: older adults (adults over age 50 with health concerns), children with asthma, or perinatal women
  • CHWs are receiving intensive training on how home visits can help assess the patient and his or her environment outside the care setting (like a clinic or hospital)
  • CHWs work as part of a care team that can include more than 10 people, including primary care providers, nurses, and medical assistants
  • Providers in MPCA’s clinics generally have been very accepting of CHWs and are relieved to have additional support
  • CHWs are trained to maximize the short time the patient has in the clinic by completing a patient assessment at the beginning of the visit

Enrollment assisters provide additional services to connect consumers with health and human services

In addition to the Linkages project, the MPCA is encouraging outreach and enrollment staff at health centers to provide services beyond application and enrollment assistance, often referred to as “enabling services.” 

Enabling services are nonclinical patient services that allow individuals to get access to health care more easily and serve to improve health outcomes. Enabling services include referrals, translation and interpretation services, and health literacy.

MPCA’s Enabling Services program recognizes the growing demand for additional services and uses existing trained enrollment staff to meet patient needs. By providing additional help through enabling services, health centers can more broadly address the comprehensive needs of consumers. Outreach and enrollment staff are well-equipped to provide these types of services because of their connection to patients, consumers, the community, and community programs. 

Furthermore, consumer needs frequently arise during enrollment appointments because of the nature of questions asked when enrolling in health coverage. For example, when a navigator inquires about a consumer’s health needs during the plan selection process, it may become clear that transportation is difficult for the consumer, which could be a barrier to attending health appointments. Enrollment assisters are well-positioned to identify this need and connect the consumer to the appropriate service (such as transportation) the health center offers. 

As more and more people get covered, it is important to address evolving consumer demands and help people who are newly insured get access to health care once they have health coverage. 

MPCA is using a variety of innovative approaches, including placing CHWs in clinics and using expertise from outreach and enrollment workers, to meet these demands. We look forward to monitoring the pilot program’s success to see its effects statewide.