Q&A with Dr Shreya Kangovi: “Being a community health worker is a profession, and it’s really important”
What can community health workers do for provider organizations and how does your center help with this?
Most of your audience knows who Community Health Workers are and have heard magical stories of trust and power being restored from someone. We’ve heard those stories too, but we’ve wondered, “How do you do magic with consistency?” How do you prepare community health workers to be successful every time? This is what we have tried to build with our IMPaCT model (Individualized management for patient-centered targets).
Turns out, you have to do a lot of things right to pull off this magic. You need to hire the right people who are trustworthy and have that shared life experience. You need training at all levels—community health workers, their supervisors, managers. Then you have to find the balance between clinical integration. We want community health workers to be part of care teams, but we also want them to retain that core identity that really defines them.
Next, you need to design work practices that allow them to meet patients as people, not as checklists. It is not a filtering and SEO platform. It’s about getting to know people and asking them what they need to live their best life and do those things. And you need infrastructure, supportive supervision, salary, career ladders, etc., so we designed IMPaCT as the best practice model to achieve this.
What results have you seen?
We’ve now tested it in four randomized controlled trials on all kinds of patients, different conditions, different settings, inpatient, outpatient, and we’ve seen consistent results. It improves the quality of health care, HCAHPS, as well as access to care. It improves real health outcomes, like chronic disease control, mental health, patient satisfaction. And it reduces hospitalizations by 65%. We recently published a study based on the results of these trials which showed that the initiative returns $2.47 for every dollar invested by the payer during the fiscal year.
We’re starting to see them replicated in places outside of the Philadelphia area where we started doing this work. Based on some of these results, we are considering a national scale. We’ve built programs not just in Philadelphia, but in 20 states.
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What can CEOs learn from this model?
Often, CEOs may view community health workers as simply service personnel who work with victims of injustice and inequity. But health inequity is a psychological condition that begins with people who have privilege. Those of us who are privileged, we become susceptible to psychological distortions, whether it be racism, xenophobia, greed, and these distortions find their way into our politics, which then affects the distribution of power and resources within our institution, indeed throughout society. This affects living conditions, behaviors and health. There is a chain reaction that ends with the patient, but begins with the leaders. We wanted to ask ourselves, “How can community health workers not only solve the right side of the equation by mentoring people, getting them tokens up and helping them live their best lives, but how can- they go upstream and really intervene at the root of the inequity?
So Ashley Harris, who is a fellow community health worker of mine, myself and a few other team members designed an executive training experience for a healthcare organization’s C-suite. This is a small-group experience where five C-suite leaders are paired with five community health worker mentors, and there is a combination of one-on-one sessions in addition to small-group interaction. They get to know each other’s stories. They use it to explore why our stories are so different. Why do community health workers talk about having been homeless or losing someone to violence or facing economic hardship? Suite C has a truly different lived experience. What are these structural forces that shape our lives?