Medicine
In late 2011, I attended an academic meeting where the subject of community health workers came up in a discussion. Earlier that year I had read about Vermont's ambitious blueprint for medical homes integrated with community health teams, so I volunteered that we needed fewer specialists and more trained laypersons with ties to their communities to implement prevention strategies. Another physician objected that while community health workers might work well in lower-income countries like India, we didn't need to deploy them in America, where people already know from their doctors that they should eat healthy foods, watch their weight, exercise, and not smoke and don't need others nagging them about it.
But should community health workers be viewed merely as extensions of medical institutions when large proportions of the population will not visit a doctor in a given year? An alternative model, wrote Health Affairs editor Alan Weil,
views CHWs as part of the communities in which they work. The roles of community health workers are defined by the community and CHWs through a process of community engagement. CHWs are valued for their contribution to community health, not for the savings they generate for health plans or providers. CHWs are embedded in the community, not in a clinician’s office or hospital. Advocacy is required to effect a transfer of resources out of clinical care into the community.
On the other hand, a New England Journal of Medicine commentary observed that the absence of connections between community health workers and family physicians can leave them working at cross-purposes:
CHW services are commonly delivered by community-based organizations that are not integrated with the health care system — for example, church-based programs offering blood-pressure screening and education. Without formal linkages to clinical providers, these programs face many of the same limitations — and may produce the same disappointing results — as stand-alone disease-management programs. CHWs cannot work with clinicians to address potential health challenges in real time, and clinicians can't shift nonclinical tasks to more cost-effective CHWs. Indeed, clinicians often don't recognize the value of CHWs because they don't work with them.
(1) Minimize expenses by sharing resources and avoiding cost ineffective interventions
(2) Concentrate on high utilizers
(3) Foster relationships with both providers and patients
(4) Track patients across the medical neighborhood in real time
(5) Extend rather than duplicate the efforts of primary care practices
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As reviewed on this blog and in many other sources, the relative underinvestment of resources in primary care in the U.S. has a great deal to do with the fact that we spend far more on health services than anywhere else in the world but rank near...
- Welcoming Health Centers To The Medical Neighborhood
Early in my career, I provided patient care at several community health centers in Washington, DC, and until recently, my wife served as the medical director for two area health centers. In fact, our own family doctor (who cares for...
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Medicine
Community health workers can complement primary care
In late 2011, I attended an academic meeting where the subject of community health workers came up in a discussion. Earlier that year I had read about Vermont's ambitious blueprint for medical homes integrated with community health teams, so I volunteered that we needed fewer specialists and more trained laypersons with ties to their communities to implement prevention strategies. Another physician objected that while community health workers might work well in lower-income countries like India, we didn't need to deploy them in America, where people already know from their doctors that they should eat healthy foods, watch their weight, exercise, and not smoke and don't need others nagging them about it.
But should community health workers be viewed merely as extensions of medical institutions when large proportions of the population will not visit a doctor in a given year? An alternative model, wrote Health Affairs editor Alan Weil,
views CHWs as part of the communities in which they work. The roles of community health workers are defined by the community and CHWs through a process of community engagement. CHWs are valued for their contribution to community health, not for the savings they generate for health plans or providers. CHWs are embedded in the community, not in a clinician’s office or hospital. Advocacy is required to effect a transfer of resources out of clinical care into the community.
On the other hand, a New England Journal of Medicine commentary observed that the absence of connections between community health workers and family physicians can leave them working at cross-purposes:
CHW services are commonly delivered by community-based organizations that are not integrated with the health care system — for example, church-based programs offering blood-pressure screening and education. Without formal linkages to clinical providers, these programs face many of the same limitations — and may produce the same disappointing results — as stand-alone disease-management programs. CHWs cannot work with clinicians to address potential health challenges in real time, and clinicians can't shift nonclinical tasks to more cost-effective CHWs. Indeed, clinicians often don't recognize the value of CHWs because they don't work with them.
How can we bridge this gap? A recent review in the Annals of Family Medicine provided a list of structure, process, and outcome factors to consider for patient-centered medical homes to partner with peer supporters (a.k.a. community health workers).
For complex patients with multiple health conditions, care coordination is a key role where community health workers could potentially be more successful and cost-effective than expensive projects led by registered nurses or physicians. Reviewing the past decade of Medicare demonstration projects, researchers from the Robert Graham Center drew five lessons for future coordinated care models:
(1) Minimize expenses by sharing resources and avoiding cost ineffective interventions
(2) Concentrate on high utilizers
(3) Foster relationships with both providers and patients
(4) Track patients across the medical neighborhood in real time
(5) Extend rather than duplicate the efforts of primary care practices
Although optimal integration between the roles of community health workers and primary care teams is easier to describe than to achieve, moving both groups toward the common goal of communities of solution will be essential to protecting the health of the whole population.
- What Can Rwanda Teach The U.s. About Primary Care?
The relative underinvestment of resources in primary care in the U.S. has a great deal to do with the fact that we spend far more on health services than anywhere else in the world but rank near the back of the pack in key health metrics such as...
- Welcoming Health Centers To The Medical Neighborhood
Early in my career, I provided patient care at several community health centers in Washington, DC, and more recently, my wife served as the medical director for two area health centers. In fact, for several years we saw our own family...
- What Can Rwanda Teach The U.s. About Primary Care?
As reviewed on this blog and in many other sources, the relative underinvestment of resources in primary care in the U.S. has a great deal to do with the fact that we spend far more on health services than anywhere else in the world but rank near...
- Welcoming Health Centers To The Medical Neighborhood
Early in my career, I provided patient care at several community health centers in Washington, DC, and until recently, my wife served as the medical director for two area health centers. In fact, our own family doctor (who cares for...
- Family Physicians And Communities Of Solution
Every so often, American Family Physician reviews a public health topic, such as outdoor air pollutants, disaster preparedness and response, or reducing the effects of climate change. And occasionally we receive feedback from readers who suggest that...