Community health workers essential to improved health care, cost savings

Patient-centered care is the new buzzword, but in most settings, doctors, nurses and other health care professionals are really in the driver’s seat. But a University of Pennsylvania Health System program lets patients decide what they realistically want to achieve — and it has produced a measurable, replicable model that improves medical outcomes and saves money.

Details of Penn’s Center for Community Health Workers and its IMPaCT model of care can be found in the latest case study released by “The New Philadelphia Casebook: Studies in Health Care Innovation,” a preeminent publication that is part of the Health Care Innovation Collaborative, a CEO Council for Growth initiative to draw attention to the Greater Philadelphia region’s accomplishments in health care.

Short for Individualized Management for Patient-Centered Targets, the IMPaCT model was developed and launched by Dr. Shreya Kangovi, a visionary physician at Penn’s Perelman School of Medicine. It sends community health workers (CHWs) into disadvantaged Philadelphia neighborhoods to try to improve residents’ health. Instead of relying solely on the marvels of modern medicine, the program pays attention to the social, economic and behavioral factors that shape people’s health.

Studies show it has improved health care, is replicable and saves $2 for every $1 spent. IMPaCT is drawing interest from health systems across the country.

“The million-dollar question in this field is ‘Can you achieve hard outcomes by addressing the non-medical issues that affect patients’ daily lives?’” Kangovi said. “We showed you could.”

IMPaCT serves to about 2,000 patients a year at Penn Medicine. CHWs meet with each patient and get to know them as people.

They ask the patient: ‘What do you think you need to improve your health?” CHWs then provide flexible support based on patients’ needs and goals. For instance, CHWs might help a patient write a letter to estranged family members, get a wheelchair ramp for their house or join a swimming class at the local YMCA.

A hallmark of the efforts is the creation of action plans by CHWs that rely on patients’ input and take into account personal circumstances such as unemployment, social isolation and housing difficulties.

Asking patients what they think they need to improve their health “is an incredibly powerful question because it elicits what patients want and it gets buy-in,” Kangovi said.

IMPaCT’s innovations extend to the hiring process, searching for residents who already help their neighbors and possess skills such as empathy, problem-solving and communication.

IMPaCT’s effectiveness has been shown in two studies — one in the April 2014 JAMA Internal Medicine and another in the August 2017 American Journal of Public Health. One found IMPaCT’s hospital transition intervention achieved its primary goal and is a scalable strategy for implementing patient-centered care. The second found that patients who worked with CHWs to develop health goals and an action plan had fewer hospitalizations.

Health systems across the country have expressed interest in IMPaCT to the point that disseminating the model has become a program priority.

“The fact that health systems are interested in replicating this success shows that the Greater Philadelphia region is not just home to innovations that work here. Our health care community is developing practical ideas that can be advance the entire field,” said Claire Marrazzo Greenwood, executive director and vice president of leadership engagement for the CEO Council for Growth, a council of the Chamber of Commerce for Greater Philadelphia. “These case studies highlight the fascinating and groundbreaking work being undertaken every day in Philadelphia.”

In January 2018, the CEO Council for Growth began releasing innovation case studies on a monthly basis. The releases and future studies include:

  • MedCrypt, a technology security company specializing in encrypting and securing medical device data, which received support and investment from Radnor-based Safeguard Scientifics, a growth-capital company. The case study can be found here.
  • iBreastExam, a handheld breast cancer screening tool spearheaded by Drexel University. The device has been used in India to screen 75,000 women for breast cancer. It has screened women in Myanmar and will be launched in Mexico. The case study can be found here.
  • Facilitated Health Networks (FHN), an Independence Blue Cross initiative to decrease health care costs without sacrificing quality, access and patient experience. FHN has signed on three key partners: Jefferson Health, Holy Redeemer Health System and the University of Pennsylvania Health System.
  • Frontier Programs from Children’s Hospital of Pennsylvania (CHOP) provides extra funding and support for CHOP’s most promising enterprises. Seven programs have been funded since 2015, with strides made in the fights against leukemia, inflammatory bowel disease and mitochondrial disease.
  • Thomas Jefferson University is reshaping medical education with an infusion of design thinking. Collaborating across disciplines, students in medicine, design and engineering build skills for finding solutions in the health care landscape of the future.
  • Care Link, a robust information technology-enabled network of care coordination support services created by Christiana Health Services. It uses IT systems to access all available sources of a person’s health data so that health care professionals can work together to assist a patient.