December 12, 2012 -- Dr. Ralph Eccles can tell his patients they should eat a better diet, quit smoking, exercise more and watch less TV.
But they might not listen to a high-minded physician, and could lack the tools to develop better habits. Instead, the diabetes specialist at Oregon Health & Science University-Cascades East said this is a job for community health workers, such as personal health navigators — who can help people reduce the need for costly, routine hospitalizations and add years to their lives.
With coordinated care organizations taking hold, employing hundreds of new non-traditional healthcare workers is a key component — people who can help the chronically ill, those struggling with mental illness or addiction and assist pregnant women and new mothers — to lead healthier lifestyles.
A steering committee for non-traditional healthcare workers is tasked with establishing rules for training, certifying and recruiting such workers. A 2011 subcommittee drew broad guidelines and defined the roles of each worker type.
“We don’t want to undo their work. We want to make it better,” said Carol Cheney, equity manager at the Oregon Health Authority.
At the Oregon Health Policy Board meeting earlier this week, Oregon Health Authority Director Bruce Goldberg mentioned a community health worker in Grants Pass who reached out to a woman after she'd come into the emergency room four times in a month.
Richard Lewis discovered the woman had mental health and housing needs that were not being met. He hooked her up with stable housing and mental health treatment, and she was able to stop seeking help in the hospital emergency department.
"She was on a path to greater health that made a lot more sense in a way that was more cost-effective," Goldberg said.
He also told legislators that the rules and the curriculum requirements for community health workers should be established within the next six months. “We’ll be moving to full scale implementation in about a year,” he said.
These new non-traditional health care workers will have to meet certain training hours to become certified, such as 80 hours for community health workers. Also, certified workers will have their names entered in a registry before they can work for CCOs.
Evidence-based studies from across the country show that non-traditional workers can save $2-$5 for every dollar spent, and, at the same time, improve outcomes, Cheney said.
Oregon expects to become one of the first states to employ non-traditional workers on a wide scale for its Medicaid program, and could become a model for other states.
Officials plan to boost training at community colleges, while several CCOs have begun hiring from a pool of community health workers who’ve been employed more informally for years. “We don’t want to lose those existing workers,” she said.
A short incumbent worker training session will be implemented for people who recently completed such a program or have five years of work experience. New workers need more formalized instruction and testing, while making way for people whose professional strengths are less traditional or who speak a different language.
“They are professionals, but they’re professionals based on their life experiences and not their professional degrees,” said Noelle Wiggins with the Multnomah County Health Department.
“We have in our county workers who are doing a very good job but their English is limited,” said Eccles. “They’re doing a good job but their work is all done in Spanish.”
Community health workers also could assist Native Americans who are less trusting of the mainstream healthcare system or have a more fatalistic approach to health, Cheney said.
The steering committee meets again next month to adopt temporary rules before the legislative session starts.
“I think there’s so much good wisdom in this room … [what] we want to have happen is that people do good work so we don’t have to do it again,” Cheney said.
Oregon received a waiver from the Centers for Medicare & Medicaid Services to hire non-traditional workers through 2017, but needs to develop reimbursement standards so the program can continue when the waiver expires.
Image for this story by Huji Stat (public domain) via Wikimedia Commons.
