Community Health Workers – Kansas City StyleOn January 20, 2020 by Raul Dinwiddie
A statement that I’ve heard patients say over and over again is, I didn’t think that anyone cared. The most rewarding part about being a community health worker is when the patient, not when, but watching our patients grow. Watching them develop confidence in themselves and develop their ability to communicate their needs and also advocate for themselves. It’s causing people to be more aware of what resources they have for them. It’s causing them to not go to the emergency room as much and not misusing the emergency room. I think what the community health care workers bring to the table is such an opportunity
for us to influence people with health care decisions in the place where they live, in
their community. The costs savings of using community health
workers is pretty impressive. What we’d like to do is have employers, have hospitals, have
those that want to have a predicted workforce and keep people healthy. Use community health
workers in order to help achieve that. At the end of the day, I think the thing that
makes a community health worker unique, is not necessarily their education, obviously.
But, it’s an innate ability to connect with other individuals. It’s an ability to build
rapport and it’s some sense of shared experience with the community their working with. It’s caring in a way that you really easily gain trust with people. Healthcare is confusing and it’s complicated. It doesn’t really matter where you live, those barriers exists across everybody. Whether you live in poverty or you have money because it’s confusing, it’s complicated, and it’s scary. So the Kansas City Care Clinic got our start 1971 in the Kansas City community. Our core mission is to provide health care for the uninsured and the under insured. About 85
percent of patients are actually uninsured today. For new a patient that I would meet in a clinic, I would explain that I am a community health worker. And what my role would be, should they choose to participate in the program,
would be to number, advocate for them, to receive the services they’re unable to
find, or in need of. To attempt to educate them to the best of their knowledge on self-care. Provide them with as many resources as they might need. Health, social services, housing, anything. I will be someone who will be there on their side and able to translate between
them and the health care system. I am at a hospital that has a lot of under
resourced and under insured patients. So one of the things we do with Kansas City Care
Clinic is that when a self-paid patient comes into the emergency room, they are contacted. They come and they will see our patients and they will get them established with a primary care physician. We ask them a few questions. We assess what their health literacy is and whether of not they have health insurance or can afford health insurance. We also ask them about their ability to make it to their appointments, if they’re
having transportation issues or if they have a lack of contact with other care providers.
We try to assess what their needs are and then offer our assistance. Some of those patients have needs that are outside the scope of what they can do at a
primary care physician. They need somebody to follow up regarding their medications.
Maybe they have low health literacy level and so a lot of the times what I’ll do is,
I’ll put a program together where I’ll go and visit the patient in their home. I’ll see
them first in the hospital, visit them in the home. I’ve been going with one of the
Kansas City health care workers to be able to work with us together and actually see
the patient together. Which works out really well. I go over the medication list with the
patient to make sure they understand what medicines they’re on, to see how they’re healing, to see if they have any questions. Then the case worker from Kansas City care clinic comes with us and they’re the ones who actually sit with the patient as well, make sure that
they are going to go to their appointments. Sometimes even go to their first appointment with them. We do these home visits just to check up on them and to see if they’re okay, especially medically. And also to see what they’re surroundings are, to see if that’s hindering their ability to care for themselves, to go to these appointments, just to see what the underline problem is. A lot of times, the people that are working
with the patients are people that are professionals and they don’t understand their backgrounds,
they don’t understand the lifestyle that they’ve lived and where the community health workers really differ is, they’ve walked that same life of the patients. I like to think of it
as, they’re speaking the same language. Sometimes someone speaks Spanish and you speak English, and you’re not speaking the same language, so you’re not really understanding each other.
They speak the same language, so they understand what it’s like to struggle and live in poverty. What it’s like to have to use the emergency room because you don’t have any healthcare. So
they really get those pieces in a way somebody else doesn’t and the patient relates to that,
so it’s just a natural trust builder. A lot of times it is just a reminder to the
patient that if you show up and care about yourself, then they’ll show up. It’s a team
effort and you can’t always expect more from somebody else than you’re willing to invest
in yourself. Sometimes just hearing that from a level voice, someone you can relate to,
someone who has shown you, they’ll be there and that they care and that they’ll take the
time to listen, is all you need. It goes a really long way. I’m a patient at the KC Care Clinic, yes I am. I’ve been for about two years. I no longer
have to seek care at your emergency rooms or anything. So, they provide a community
health worker who has helped me tremendously. When we first started working with him, he
was homeless, a ray of chronic conditions and he really hadn’t found anyone that he
trusted to work with. A lot of times he’d go into the hospital and he’d be pretty belligerent
in that setting, so instead of people wanting to engage with him, the office that it would
happen, they would be like, oh my gosh this guy is so hard to work with. Well we started
working with him and a lot of it became it was a trust issue. He would act that way because he was afraid or didn’t really trust people in the medical setting. I was a stray. Lost. But, you know, they found me. It was a beautiful thing because I really
didn’t know about it and who they were. Since we started working with him, he’s been approved for medicaid. He’s housed, so he’s stable. His doctor was the emergency room, so in a 6 month period, he’d gone like 30 times to the emergency room. Well it’s been a year and he hasn’t gone one time to the emergency room because he goes to a doctor. But really, our piece in that is, he has a lot of questions and you know, he has a person that he can trust. So every time he leaves the doctor, he doesn’t understand something, he can call us and we can reinforce all the stuff the doctor said and we can communicate it with the doctor and the nurse, so we make sure they really understand his behaviors.
So he feels comfortable, he’s come a long way, you know, from a cost savings perspective of a hospital system, that’s a huge success. But just in, as far as him becoming healthy,
that’s an even bigger success. I consider I’m an asset. A high asset. And
credit to the community. I think every community ought to have one of these places, I really
do. It was a very good thing, it was a very good thing because it was all these doors
open. She helped me with my paperwork, her associates helped me with the paperwork, things I didn’t understand. Gave me that little push, you know, when you’ve got people helping,
I believe a person is more apt to help themselves. One of the things that I think we’ve been
accustomed to is, health care professionals is saying, come to us, we’ll take care of
you, but you come to us. This is an opportunity for us to say, we’re gonna reach out to you.
You may initially see us in the emergency room department, you may initially see us
as a patient at the hospital, but we’re gonna work with you to take your healthcare now
from the hospital to the home, from the home to the patient’s center home medical model, and back again. One of the things that I’ve loved about this program is that they are
our hands, our ears, our eyes, and so what I can’t be there to do all the time as a healthcare professional, they’re seeing things, they’re calling me. We’re in constant communication. We help advocate for them. We help with the resources. We can explain things to them. We’re here to empower people to take control of their lives and health is one of the biggest pieces, the biggest areas that can happen. I prefer to value each person and offer
them service that I know I can provide, which is the literacy, the compassion, the diligence. It’s just really amazing to see people succeed in the system because it is so complicated and I think a lot of times, the people who are implementing the healthcare, they, you’re embedded in it. So you don’t see all of those little baby steps that makes it hard for people to really make the changes that they need to in their life. So you may ask if a community health care worker is adding another layer to the healthcare cost and I guess my response would be, no. There is a cost that we have in the healthcare system if we do not take care of our patients the way they need to be taken care of. Some of what we have seen in the system is behavioral changes that are needed in the general public. I can’t go and tell you what to do, or I can and I have done that at my health literacy
level. You may, number one, not understand it, you may number two not agree with it,
and you certainly number three aren’t gonna do it just because I told you to do it. But
if I get a healthcare worker with me, who comes alongside of me. We work together, we actually go into that home. The trust level of that patient increases. We measure pretty robust number of different types of outcomes that we’re looking at. On
the cost side, we’re looking at some of the big ones that everybody else is looking at,
are we keeping people out of the ER at a rate that is different if we hadn’t work with them.
If we work with people that initiate from an emergency room, we look at overtime. Because working with a community health worker at any capacity decreases the likely hood that
you’re gonna come back to the ER. Our program, consistently over the entirety of our existence has shown that, that is true. So working with our community health workers, you’re much less likely, over a three month period, or over a six month period to come back to the ER.
Similarly looking at, are you less likely to rebound and have to be admitted again.
So looking at some of those large scale costs, one hospital system that we work with that
costs just within a single year and looking at it very conservatively, it’s about a million
dollars with only two community health workers working with that hospital. The return on
investment there is pretty high.