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By Treating Obstacles to Health, Community Health Workers Also Treat a Troubled System

Felicity Barringer
Aug 1 2017

Welcome to the world of community health workers. The job, part medical aide and part social worker, is a tradition in poor and rural communities around New Mexico and well established in similar places around the country. But institutional recognition has been slow to come.

Margarita Perez Pulida and Jorge Montoya Sosa, who work in an immigrant-heavy area of Albuquerque

Margarita Perez Pulida and Jorge Montoya Sosa, who work in an immigrant-heavy area of Albuquerque. Felicity Barringer

By Felicity Barringer

Lidia Regina was just starting a new job at the University of New Mexico Health Center in Albuquerque a decade ago when the full weight of the unfamiliar work fell on her, hard. The new job was to check in with poorer patients, find out about the problems they faced every day, and ensure that poverty, unemployment or family obstacles did not prevent them from keeping pace with the health regimen their doctors prescribed.

Her first assignment was monitoring care of clients’ new babies. “The first case I get, I’m just going to see if she wants to participate,” she said. Within five minutes, a shower of bureaucratic problems rained down. The baby had no birth certificate. Or social security number. Neither did the mother. The father was suspected of drug abuse.

Ms. Regina said she excused herself, went into an adjoining room, and screamed. Then she returned, said, “Do you want to work with me?” When the patient agreed, Ms. Regina began to assembled the data needed to get the identity cards that would make health care payments possible. She ended up working with the family for years.

In rural communities around New Mexico, community health workers are the link to a medical world that can seem alien to local cultures.

Welcome to the world of community health workers. The job, part medical aide and part social worker, is a tradition in poor and rural communities around New Mexico and is well established in similar places around the country. There are now 80,000 in the United States, and 700 or more in New Mexico. But institutional recognition for these workers, who often have only a high school degree – their main asset is being trusted by communities that are isolated from the workaday world – has been slow to come.

Now, after decades or more during which these people helped remedy social obstacles to medical care and healthy living, their work is increasingly recognized by the institutional structures at the core of modern healthcare. More than 10 states, including New Mexico, either train and certify these workers or plan to do so. Hospitals, clinics and insurance companies pay them, to identify and ameliorate what are called “social determinants.”

“Primary care providers experience a sinking feeling when, after a clinical encounter, their hand on the doorknob to leave the examination room, the patient adds one more reason for the visit — perhaps they lost their job, are unable to afford their medicine or are about to be evicted from their home,” wrote the authors of a report on health workers and their new tools. Since 2014, the state has offered a formal certification to newly trained workers, and has certified seasoned hands under a grandfathering program.

'WellRX' card used to refer patients to community health care workers
Beyond medical care In a pilot program, “WellRX” cards like this were given to patients whose doctors had concerns about their peripheral life issues.

In rural communities around New Mexico, community health workers are their link to a medical world that can seem alien to local cultures. One-third of the state’s population lives in rural areas; the vast majority of those areas have a shortage of primary-care physicians. Poverty is everywhere. Of 2 million-plus citizens, about 550,000 people currently receive their health care through Medicaid. The bill is $3.8 billion a year.

Health care workers “are usually family members and friends, and can have talks about chronic diseases and their care,” said Lynn Gallagher, New Mexico’s Secretary of Health. “They can go into the community because they know the traditions.” Ms. Gallagher spoke in March at the Rural West Conference run by Stanford University’s Bill Lane Center for the American West (note: the Center also publishes this blog).

About 48 percent are Hispanic; 10 percent Native American. A health-care worker might belong to a Native American community that is aloof to outsiders.

Health indicators in New Mexico are troubling, especially for those earning less than $20,000 a year. According to statistics from 2015, 35 percent of the people in this income range suffer from obesity, about 18 percent have diabetes, and more than 26 percent have mental diseases. Many people at this income level are concentrated in rural counties, where doctors practice what the medical community calls “frontier medicine” Two-thirds of the state’s 33 counties have a shortage of primary-care physicians; two have an extreme shortage.

A Shortage of Doctors to Practice ‘Frontier Medicine’

Map: Primary Care Physician Shortages in New Mexico, 2014
Bill Lane Center for the American West

Research Suggests Community Health Care Workers Pay for Themselves in Reduced Costs

Dr. Arthur Kaufman, the vice chancellor for community health at the University of New Mexico, has long been an ardent advocate of community health workers. “A significant change in the financing of health care has now enshrined the work of community health care workers as a ‘tangible economic benefit,’” he said. Federal Medicaid payments to insurers are now made per patient, rather than per procedure.

Mitigating Obstacles to Care | In March, The University of New Mexico’s Dr. Arthur Kaufman spoke about the ‘social determinants’ that hinder quality health care from reaching underprivileged populations.   Rural West Initiative, Bill Lane Center for the American West

New Mexico’s four approved managed care providers – Molina Healthcare, United Healthcare, Blue Cross/Blue Shield, and Presbyterian Health Plan – all pay for community health workers; salaries range from less than $10 an hour to more than $25; median pay is about $17. Their work can reduce what insurers pay in medical bills.

Such workers – Molina’s title is ‘community connection workers’ – “are kind of a door” into the homes of poor clients, said Laura Ortega, healthcare services manager for Molina. “When you see a member’s hierarchy of needs, when you see they have no food, place to live or transportation – well, if you don’t move them from that level, they don’t have self-esteem.” Self-esteem, she believes, “improves a member’s willingness to work with Molina.”

A small 2012 study showed a reduction in emergency-room visits. Patients without resources often rely on the emergency room for primary care, leading to large and often unnecessary expense. Dr. Kaufman and several colleagues followed 448 Molina patients over a six-month period, measuring their use of emergency rooms before and after they worked with community health workers. The $650,875 Molina paid for emergency room visits before the change dropped to $225,324.

More studies are in progress to show the economic impact as this traditional approach to health care, in areas that are poor or rural or both, is integrated into the health-care system. But behind the studies are encounters like those experienced by Lisa Coppedge, who works for Molina in Cuba, a small rural community in Sandoval County, or Jorge Monroy Sosa and Margarita Perez Pulido, who work in an immigrant-heavy area of Albuquerque.

Dr. Kaufman and several colleagues followed 448 Molina patients over a six-month period, measuring their use of emergency rooms before and after they worked with community health workers. The $650,875 Molina paid for emergency room visits before the change dropped to $225,324.

To do the job, Ms. Coppedge said, “You have to have empathy, to be a good listener.” In one case, she said, she visited a woman who is a victim of domestic abuse. “She lives in a run-down trailer in poor condition and she doesn’t want to move. There’s no heat, no air conditioning, no running water. No internet service. No SNAP benefits.”

“She was completely unaware of community resources – that there was a local community food distribution group that gives out wonderful food boxes. I was able to get Home Depot to donate a window air-conditioning unit for her. Local churches picked up the unit and got it installed.”

“Her health issues mostly involved mental and behavioral health. Depression. I needed to advocate for her to see a counselor. She had no car or transportation.” Ms. Coppedge helped the client deal with these obstacles, and the woman, who used to appear in the emergency room with mental breakdowns on a regular basis, now does so less often.

Now, when first meeting a patient, community health workers like Ms. Pulido and Mr. Sosa, who work at the First Choice clinic in Albuquerque, fill out a “WellRx,” asking questions about a patient’s access to utilities, transportation, child care, shelter, and food. The WellRx emerged from Dr. Kaufman’s offices; he said it is much more useful than some other required tests.

One patient Ms. Pulido helped was an 85-year-old had been missing her doctor’s appointments; the home care nurse had stopped coming after, on several visits, no-one opened the door for her. Family members had chosen to keep her isolated. When Ms. Pulido got in to talk to the patient and her granddaughter, she got the granddaughter’s assurance that the patient would now go to the doctor.

Giving Health Care Services a Friendlier Face, Bolstered with Technology

Patients’ fear of authorities – some poor immigrants see the medical system as part and parcel of threatening government agencies – is perhaps the most pervasive obstacle community health workers must overcome.

The obstacle that advocates like Dr. Kaufman had to overcome was the financial structure of the health care industry, which long created incentives for maximum payouts for procedures, and minimal payout for community and preventive healthcare. “The reason it didn’t happen in the past is because the incentives were not aligned with community health,” he said.

“The incentives for drug companies, for doctors, for hospitals, all of that was geared to fee-for-service. Not only fee-for-service but specialized care and procedural specialists’ care. Who determines that? Specialists who did procedures. You had these strange incentives that worked absolutely against community health.”

But, in a sign of the attitudinal change now underway, Dr. Kaufman said, “We just got a $4.5 million grant, five-year grant” from the federal Center for Medicare and Medicaid Services “to screen all Medicaid and Medicare patients for social determinants and for the higher risk ones to intervene and see if you could increase quality and reduce costs.” They hope to screen 75,000 patients a year in Bernalillo County, around Albuquerque. With some of the grant, he hopes to get community health workers smartphones loaded with contacts for social service agencies, local food banks, clinics, and other things they might need.

Ideally, he said, “We will be able to track where patients are sent, whether they arrived, whether there’s duplication. Everyone knows if this person has gotten food at a food bank. We don’t have to get food elsewhere. This would diminish the chance of waste.”

Increasingly, this blend of a social work and health care, long familiar to rural New Mexico, is an essential part of New Mexico’s health care delivery. Community health workers, as Secretary Gallagher said, “can actually have meaningful discussions” to change patient attitudes – and cut health-care costs.

 

 

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Compiled by Felicity Barringer, Melina Walling, Benek Robertson, Maya Burke, Kate Selig and Francisco L. Nodarse

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Articles Worth Reading: January 19, 2020

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“We’re Bound by That River,” one water expert said of the Colorado River, which supplies water to 40 million people. “All of us, regardless of our legal rights, regardless of what’s on paper, we need to consider how we can use less water. And we need to take action immediately.” The Colorado Basin and its water managers must juggle the laws that are decades old, new agreements and persistent aridity. The huge reservoirs of Lake Powell and Lake Mead have shrunk dramatically. Some observers say the rules governing distribution of the Colorado’s waters need to be fundamentally reimagined. Arizona Republic

Unlikely Coalitions Form to Block New Port Facilities to export fossil fuels. Teaming with Native Americans, ranchers and sportsmen, environmentalists have worked to block nearly every effort to export coal, oil and liquified natural gas from the West Coast. They just claimed another major victory this month – the latest of more than two dozen -- when a proposed coal-export terminal in Washington state was called off. Associated Press

“Fossil” Groundwater Is Being Depleted in California, and its users can’t rely on it being replenished any century soon, according to new study. If the water tucked underground for 100 centuries is used for the crops and pools of the 21st century, the fossil water stores will disappear for good. “It’s just like taking gold out of the ground, out of a mountain,” said Menso de Jong, the study’s lead author. “The gold is not going to grow back.” San Jose Mercury News

Apaches Sue to Stop First Step in Approval of Copper Mine Near Sacred Site. If an environmental study’s publication is blocked, the process of approving the mine planned by Resolution Copper might be derailed. A podcast interview with the reporter covering the controversy, Debra Utacia Krol of The Arizona Republic. KSUT

To Help Rural Economies, One-Third of Spotted Owl Habitat in Oregon Was Excluded from Protection. The size of the protected acreage has yo-yoed from one administration to the next, but this cut in protected areas is one of the biggest on record. The amount of habitat protected in the Obama administration was more than 9 million acres; the Trump administration in its final days cut that by more than 3 million acres. E&E News

Rural Coloradans Seek to Contain Light Pollution. NASA photos of Colorado from space show a widening urban white-out reaching into rural areas. The dark-sky zones that southwestern Colorado leaders are proposing in areas like the San Luis Valley would, all combined, cover more than 3,800 square miles — the largest official area protected from artificial light on the planet. Denver Post

Wildlife Take Stock of Photographers Taking Stock of Wildlife. “Animals interrupting wildlife photographers,” a thread by the Catalan journalist Joaquim Campa. Twitter

Articles Worth Reading: December 7, 2020

New Data Shows Lethal Damage to Coho Salmon Is From Tire Residue, as researchers double-down on the findings about tires’ environmental damage. One chemical, 6PPD-quinone, interacts with ozone and becomes highly toxic to Puget Sound salmon, taking out 40 to 80 percent of returning salmon before the spawn. The problem extends from Washington state, where scientists have been studying the issue, to California; tires are the largest source of microplastics in San Francisco Bay. The Seattle Times Los Angeles Times

With Legal Barriers Gone, More Westerners Are Harvesting Rain to supplement the disappearing water in the Colorado River and the Ogallala Aquifer. Rainwater harvesting—a cheap, low-barrier, low-energy method—may provide one piece of the long-term solution to water shortages in a region where climate change is intensifying droughts. Today, rainwater capture is legal in every state, though many have restrictions. A few, like Colorado, didn’t legalize it until 2016 and still restrict the total amount harvested. The Counter

A Navajo-Majority County Commission in Utah Calls for Restoring the Bears’ Ears Monument to its original size. The Trump Administration dramatically reduced the monument from 1.35 million acres to two separate areas totaling 200,000 acres. The San Juan County Commission voted 2-to-1 to make the request, with its two Navajo members in the majority. Associated Press

In the Wake of Fierce Fires, A Sudden Burst of Logging in Colorado. State foresters are overseeing wholesale mechanized tree-cutting, as tractors dig holes up to 140 acres in size are appearing among the lodgepole pines. A hot national wood-products market snaps up the lumber created in Colorado, which has never traditionally been a logging state. Across western Colorado, insect attacks on old and drought-enfeebled trees over the past decade have left 5 million acres of skeletal trees in a region climate change has made susceptible to wildfire. This year, 700,000 acres burned. Denver Post

As Insurers Blanch at Newly Calculated Wildfire Losses — $24 Billion in the U.S. in 2018, they continue to flee fire prone areas. In California alone in 20219, insurers pulled coverage from more than 230,000 homes — about 31 percent more than the year before. California regulators want to keep private insurers from fleeing the state, but know that climate change is changing everyone’s risk calculation. Bloomberg

Graphics & the West

Where California Grows Its Food

See the most detailed survey ever done of crops and land use in California. It covers nine million acres of land devoted to grapes, alfalfa, cotton, plums, you name it – food for people and animals all over the world. View map »

California's Changing Energy Mix

A look at the energy sources California utilities have used gives us insights into the state’s progress in decarbonizing its electricity supply. In 2015, 35% of total electricity generation (in-state generation plus imported electricity) came from zero-greenhouse-gas sources, which include solar, wind, hydropower, and nuclear. View Graphic »

U.S. Conservation Easements

Conservation easements of various kinds cover more than 22 million acres of land in the United States, according to the National Conservation Easement Database, a public-private partnership. Take a look at our interactive map of nearly every conservation easement, with details on over 130,000 sites. View map »

 

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