Traditional Health Workers October 26, 2015 April Johnson, MPA Health Equity Workforce Manager

Overview Health Equity Workforce Introduction Purpose and Role of THWs THW System Updates THW Commission and Subcommittees System Coordination Medicaid Rule for Prescribing THWs for Preventative Services Payment Methods

The Goal of the Health Equity Workforce Program is to: Advance health equity Help achieve the Triple Aim*…improving patient experience (including quality and satisfaction), improving population health, reducing per capita health care costs Grow and diversify our health care and public health workforce

Traditional Health Workers: A Community-Based Model of Care Community Health Workers; Peer Support; Peer Wellness Specialist; Personal Health Navigators; and birth Doulas Health and social service systems Individuals and Communities

Purpose of Traditional Health Workers Reduce costs associated with health care and burden on society Understand and address the social determinants of health Address health disparities in culturally- appropriate ways Take a less siloed approach to health care

Role of the THW A Traditional Health Worker (THW) is a frontline health professional who applies his or her unique understanding of the experience, language and/or culture of the populations he or she serves in order to carry out one or more of the following roles: Providing culturally-appropriate health education, information and outreach in a variety of settings such as homes, clinics, hospitals, schools, shelters, local businesses, and community centers; Bridging/culturally mediating between individuals, communities and health and human services, including actively building individual and community capacity; Assuring that people access the services they need; Providing direct services, such as informal counseling, social support, care coordination and health screenings; and Advocating for individual and community needs.

Training and Certification Training Program Requirements Certification Requirements Training curriculum must meet standards required by OARs 410-180-0350 by THW type Must be 18 Years of age Must pass a criminal background check Must be trained by an OHA approved training program unless grandfathering or provisionally applying Must submit a completed application to OEI with I.D.

THW System Updates

Traditional Health Worker Commission and Subcommittees Systems Integration Scope of Practice TEMPS

Training Evaluation Metrics Program & Scoring Subcommittee Develop the metrics, standards & guidance needed to review and approve THW training program applications and establish the metrics, standards and guidance for continuing education requirements for all traditional health workers who wish to qualify for (re)-certification by the Oregon Health Authority.

Scope of Practice Subcommittee Develop roles, expectations, and supervisory relationships as outlined in Division 180 THW Rule 410-180-0370 for Community Health Workers, Peer Wellness Specialists, Personal Health Navigators, and Peer Support Specialists Certification Curriculum Standards to faciliate appropriate hiring of THWs

Systems’ Integration Subcommittee Integration of the THW workforce into the health care system by analyzing opportunities and barriers to employment and creating a strategic plan to improve health equity to underserved populations. Strategies may include outreach, training, and education of CCOs and other community based organizations, monitoring and reporting on employment standards such as wages, benefits, and scope of work

State Level THW System Coordination Transformation Center Office of Equity and Inclusion Medical Assistance Programs Community College Workforce Development Board Traditional Health Worker Commission Office of Information Systems

Transformation Center Coordination THW Survey Survey is currently fielding with CCO’s across the state. THW Webpage THW Toolkit THW Stories Videography Project THW Registry Securing funding for THW registry enhancements

THW Registry Enhancements Health Equity Workforce (HEW) team has partnered with the Transformation Center and OIS to fund registry enhancements that will: Collect and sort relevant data, e.g., race/ethnicity, geography, and by worker type; Notification to THWs for recertification; Provide HEW team with notification of newly submitted applications; and result in an improved system for providers to locate and hire THWs.

CCWD Coordination Statewide Needs Assessment Survey Incumbent Workforce Assessment Training of CHWs

Medical Assistance Programs 42 CFR 440.130 (c) Rule Change- The CMS final rule published on July 15, 2013 included a change to the regulatory definition of preventive services at 42 CFR 440.130(c) of the federal Medicaid program. Previously, preventive services could only be provided by a physician or other licensed practitioner (OLP) of the healing arts for Medicaid reimbursement practitioners, OLPs, can provide and be reimbursed for furnishing preventive services recommended by a physician or other licensed practitioner

Current Funding Mechanisms In most delivery systems THW services are funded using braided payment methods. For example, the behavioral health system uses a variety of federal, state, and local resources to fund Peer Support Specialist. Public Health has historically provided Community Health Workers in underserved communities to provide training, outreach, education and testing to stop the spread of communicable diseases and to eliminate infant mortality. These programs are grant funded and their duration is often limited due to emerging national and global health priorities.

Examples of Payment Models for THWs Peer Support Specialist Community Health Workers Oregon providers can purchase peer services through funding sources such as: Federal (SAMHSA, TANF, Medicaid), State and Local Funding, Private funding; and Drug Courts (federal, state and local funding), and DOJ funding Oregon providers currently purchase CHW Services with: CDC grants (Public Health; HIV Testing and Education) Foundation Grants (Legacy Emanuel-ER CHWs) Provider Investment (Central City Concerns-FQHC, Housing and Behavioral Health) CCOs (Pilot Project)

QUESTIONS?

Contact Us: April Johnson, MPA Medicaid payments for THWs: Health Equity Workforce Manager Don Ross Office of Equity and Inclusion Manager 971-673-3389 DMAP Policy and Planning Section April.r.Johnson@state.or.us 503-945-6084 donald.ross@state.or.us Shawn Clark Peer Delivered Services Coordinator Addictions and Mental Health Division 503-945-9720 shawn.clark@state.or.us THW Committee Website: www.oregon.gov/oha/oei/Pages/non-traditional-health-worker-committee.aspx Subscribe to mailing list through website for updates. THW Rules: http://www.dhs.state.or.us/policy/healthplan/rules/notices.html (N)THW Report: www.oregon.gov/OHA/oei/docs/nthw-report-120106.pdf HB3311 Report: www.oregon.gov/oha/legactivity/2012/hb3311report-doulas.pdf