1. Community Health Workers: From Rhetoric to Reality
Shreya Kangovi, MD, MS
Division of General Internal Medicine, Perelman School of Medicine
Penn Center for Community Health Workers
University of Pennsylvania
MN CHW Alliance Workshop
December 1st, 2015

2. Penn Center for CHWs
Improve health in high-risk populations through the effective use of CHWs

3. Penn Center for CHWs
Improve health in high-risk populations through the effective use of CHWs

4. Penn Center for CHWs
Improve health in high-risk populations through the effective use of CHWs

5. Penn Center for CHWs
Improve health in high-risk populations through the effective use of CHWs

6. Penn Center for CHWs
Improve health in high-risk populations through the effective use of CHWs

7. Penn Center for CHWs Research: Design, test and refine CHW programs
Direct Care: IMPaCT for 1,500 pts annually
Dissemination: Tools, training, technical assistance for > 450 organizations.

8. Design

9. Lessons from History Kangovi, Grande, Trinh-Shevrin NEJM 2015
Photo Credit: Quora.com

10. Lessons from History Hiring Work practice Integrated Patient-centered
Evidence-based
Kangovi, Grande, Trinh-Shevrin NEJM 2015
Photo Credit: Quora.com

12. Design Map Barrier Intervention Trait Skill
Patients want to be heard and do not want to feel judged
CHW conducts open-ended, strengths-based interview
-Nonjudgmental
-Listens > talks 
Qualitative Interviewing 

14. Recruitment

15. Patient-centered
Set goals
Support
Connect

16. Standardized program

17. Integration with clinicians
-CHWs communicate through EMR, telephone, huddles - IMPaCT Teaching Service

18. Integration with clinicians
“[CHW] is symbolic of the highest standards of patient advocacy and the best our health system offers its patients.” -Nurse “I was just so grateful that people did this work. I was glad to learn how to do it better, to establish this patient dynamic.” -Student

19. Randomized Controlled Trial (n=446)
Kangovi et al, JAMA Internal Medicine 2014.

20. Ongoing RCTs
Single-center randomized controlled trial of 6- month IMPaCT among patients with multiple chronic conditions (n=212)
Multi-center randomized controlled trial at VA, academic, community sites (n=444)

21. Outcomes  Sustainability
Funding
Status
Access to primary care
Provider
Preventable hospitalizations
Payer/Provider
Patient satisfaction
Student education
Medical School
Cost-effective workforce
Practices
Chronic disease control

22. Future directions

23. Penn Center for CHWs
Improve health in high-risk populations through the effective use of CHWs

24. What does success look like

25. Income differences in health
A Guide to Measuring the Triple Aim, IHI 2012

26. No income differences in health
A Guide to Measuring the Triple Aim, IHI 2012

27. Key Questions Is this working? For whom? How can we make it better?
Quality often suffers with growth: can we prevent this?
How can we bring a non-medical intervention firmly into healthcare without breaking it?
Can we capture an opportunity moment for CHW programs? Or will history repeat itself?
How do we fix underlying problems, not just Band-Aid?
What will keep our organization happy and stable?

28. 5- year plan Mission Strategic Priorities
To improve health in high- risk populations through the effective use of Community Health Workers
Understand and improve outcomes
Expand high-quality care
Drive clinical integration
Support CHW programs across the country
Advocate at local, state and national levels
Build a stable organization that promotes human capital

29. Conclusion

30. Collaboration

31. Acknowledgements Judith A. Long, MD Tamala Carter, CHW
David Grande, MD, MPA
Karen Glanz, PhD, MPH
Richard Shannon, MD
Natalie Levkovich
Sharon McCollum, CHW
Joan Doyle, RN, MSN, MBA
Mary White, CHW
Garry Scheib, MBA
Casey Chanton, MSW
Phyllis Cater, BA
Robyn Smith, BS
Horace DeLisser, MD
Raina Kulkarni, BS
David Asch, MD, MBA
Nandita Mitra, PhD
Roy Rosin, MBA
Jill Feldstein, MPA
Susan Day, MD
Marisa Rogers, MD
Liyuan Ma, MS
Josh Metlay, MD
Ralph W. Muller, MA
Katrina Armstrong, MD