In this episode we talk about the role of the community health worker in case management with Kari Curry, director of clinical services for Emtiro Health, where she oversees the delivery of their population health management program.

Kari Curry, welcome to the Move to Value Podcast

Thank you

Tell me about your role at Emtiro Health. Who is your patient population and how are you assisting them in obtaining the best possible outcomes?

Well my role at Emtiro Health is the director of clinical operations. We case manage the managed Medicaid population. I've been with the organization even before it was Emtiro. I was a care manager myself and I covered Davidson County. I then was a supervisor for the care managers covering Davidson County when it was Northwest Community Care, so my role with Emtiro then moved to manager of clinical services and then I moved to the director position of clinical operations. I believe the past roles I've had allowed me to truly understand the role of the care manager, including you know barriers that they encounter with patients. And working with the Medicaid population is a passion of mine as well. As Emtiro as a whole, we've worked with this vulnerable population for years and we continue to provide efficient care to the Medicaid patients. So our vision here at Emtiro is to coordinate care, improve health outcomes, build strong communities, and health equity and I truly believe we work hard every day to meet that vision and we are passionate about working with the vulnerable populations and improving their health outcomes.

So in your Move to Value Summit presentation, you mentioned that case management is like a puzzle. Tell us why this is so and how do you work to solve it.

Yeah so I'm sure my staff is tired of hearing me say that but it's true. The first thought came to me when I was doing case management in a hospital. So I was a discharge planner and I did utilization review for patients admitted to the hospital and when a patient was nearing discharge, I would need to make sure they had a safe discharge plan. So to ensure they had a safe environment, such things as utilities in the home, any medical equipment that they may need making sure they have their medications, and so on. So each part of that discharge plan was like a piece of a puzzle where each piece must fit together to see the discharge plan be successful. And that theory has carried with me here at Emtiro and I still find it true today.

So as a care manager for managed Medicaid, each area is the puzzle piece. Each patient is assessed for medical conditions education, social determinants of health, medications, etcetera. So each area must come together to see the patient situation and what steps are needed to ensure the patient receives what they need.

Well how have you seen the impact of the community health worker in care delivery and how is this impact achieved?

So when I first started my nursing career, community health workers were not a title that I was aware of or that you heard a whole lot. It has become more popular and a more popular term over the last few years. However, the work of a community health worker has always been there. So when I started in care management, I did it all. I made home visits, worked with the patients on their medical conditions, assessed for social determinants of health, and set up the patients with those services if they were needed. And I can honestly say as a nurse, I wish I would have had more time to focus on the patient's medical conditions and providing that education to reduce risk of ED visits, or readmissions, or overall living, you know, as far as a healthier lifestyle for those patients.

So the role of the community health worker of course is designed to tailor you know and meet the needs of communities they serve. Community health workers have made a huge impact on the services provided to patients because they focus on the social determinants of health in ways to make sure the patients receive the appropriate community resources and appropriate services. It makes the job of the care manager a bit easier because it is more streamlined, and the roles are more defined. So, like I said earlier you know we could all be considered a puzzle piece because we all have a specific role to play to improve that patient outcome.

Emtiro manages primarily a Medicaid population so if you would, tell me some of the responsibilities the community health worker has in working with this population.

There's always been a stigma attached to Medicaid patients and the Medicaid populations and the patients feel that. So the Medicaid population can be considered a vulnerable population. But it does not mean that they deserve any less care or services than other populations. So here at Emtiro, we work hard to reduce and redefine that stigma. We advocate for our patients and ensure they get the services they need in order to live a healthy successful lifestyle. And I can say I've had times where I go to see a provider and they have their laptop or iPad in hand, and they never look at me while I'm talking to them and let them know what's going on with me. So that could be very disheartening even for me much more for a vulnerable population.

Our community health workers at Emtiro help focus on the patient as a whole. They build rapport with the patient they meet the patient where they are in their current situation. They advocate for their patients and work hard to ensure the patient has the community resources they need. But it doesn't just stop there. They follow up with the patient to assess that the community resources were successful and make the patient know that they care about their health and want to see them succeed. Having a personal relationship with the patients can go a long way.

So Emtiro employs community health workers?

Correct

Was having community health workers always part of the strategy or was that something that was implemented as the need arose? Can you speak to that a little bit?

So when we were Northwest Community Care, it was more RN focused and the RN did it all. So when we went with Emtiro Health and knew that we were going to manage managed Medicaid patients, we took a look at what all services we could provide as a whole. So that included RN's, it included a pharmacist for a while, community health workers, even LPN’s. So we wanted to encompass all of that to provide our you know services to the patients to the best of our ability. And what we have found doing that care model is the patients are receiving better care. They're having that one-on-one conversations the one-on-one attention that they need to really focus on their health, so I think it's been a great thing to have.

Well would you mind sharing a story about how you've seen a community health worker impact the outcome of a patient in a positive way?

So I'm sure the community health workers can offer lots of stories, but one of them came to me and provided a story about how she had been working with a patient who was living in a homeless shelter. And a situation happened, occurred and the patient had to leave the homeless shelter. So she was living in her car. Well, the community health worker engaged her, reached out to her, come to find out she had a mental health diagnosis and that prevented a lot of the shelters from taking her. So, the community health worker took the extra step. Partnered with the community resources within that county. They are currently looking for her a permanent place to live but they did find a shelter that was willing to take her and she's allowed to stay there until her permanent residence is set up. So that was a really great thing a very positive story.

We have another story to where one of the community health workers was working with the mom with small children in the home and the mom wasn't worried about herself so much but feeding her kids. So the community health worker worked with her and a local food bank and food pantry and set her up to receive food every two weeks and that continues to happen now. In that circumstance, the care manager is also working with her and she has reduced her amount to the ED, which is great, so we've had a really good outcome with that.

So, while these folks are doing all of this amazing work, it has to be difficult and there are plenty of barriers that pop up in various ways, either with a patient or with a collaborative organization or just rules and regulations.

Right.

What have you seen that are some of the issues or barriers that the community health worker faces?

So, I really like this question because I think we can talk all day about the amazing work that the community health workers do but it's also important to assess the issues and barriers they face. So I think one of the biggest challenges for the community health workers is just unable to reach patients with the phone numbers provided. So when the wrong contact information is listed, the community health workers have to do more research on their end to try to engage the patient. So that can be looking for information in an HER, maybe looking at claims data to see if there's a pharmacy listed, call the pharmacy to see if they have an updated number for the patient, and also just engaging the patients can be a difficult task. This is where motivational interviewing comes into play, especially when you were actually able to engage them. So some of the other challenges could be social conditions, mental health status of the patient is a big one, because I think we lack a lot of community resources based off that. So I believe it's important to continuously to assess those barriers and brainstorm of ways to reduce them if at all possible.

So, as you are well aware, health care is making a shift to fee for value and it is proven that the community health worker impacts a lot of the work flows in a positive way, such as reducing utilization, helping to reduce cost. How do you see the community health worker making a difference in value based care?

So with North Carolina Medicaid they continued to reform you know delivery of care, and payment, with the goal of improving the health of patients overall. I think it's important to keep the focus on the whole person and centered care whole person centered care and ensure those services not only address medical but non-medical conditions as well. So, assessing those social determinants of health is a key part of providing well-coordinated care to the Medicaid population. I believe being an advocate for the patient is also a key driver, having to be that bridge between providers patients and community resources is crucial in having positive desired outcomes for any vulnerable population.

So, when you talk about community resources what do you see as one of the most utilized resources out there? What do people need the most?

I think food. Food banks, food pantries right now. Even now with the cost of food going up. A lot of patients can't afford it. So you know then you run into what the pandemic you know the effects of the pandemic had on those resources as well. You know we had a lot of food banks that just didn't have enough food to cover those patients. So that's when churches got involved, that was always helpful. But I think food insecurity is probably the top. The most needed is mental health, by far.

Why?

I think the majority of our population has a mental health diagnosis. There's not enough resources for these patients. There's too many and a lack of resources even in trying to get them involved in a behavioral health facility or mental health provider. It can be difficult because, one, the patient, sometimes they require group therapy and the patient doesn't feel like talking in front of others. So that's always a problem. Transportation to those facilities is always an issue, but I do think there's just a lack of mental health availability to these patients.

Has there been an uptick in this mental health crisis that we're in, or has it always been there and just not acknowledged? Or do you feel like there is a catalyst for this that's only going to get worse or has been making things worse?

I think it's always been there. It's always been an issue when it comes to healthcare especially care management. So, I think it's always been there, but I think it has gotten worse and especially with the pandemic as well. You know, even health care providers, you know look what we had to go through as well, and the burnout. So, I think it continues to be a need. However, I do think it has increased due to the pandemic. I also think just with the way the world is now, you know things are different than they were even ten years ago, and I think I can see an increase in the younger population, too, as well. So, school age kids from elementary to high school you know have really struggled because we did remote learning, and you know they were isolated for so long and the fear of going out. So, you know that doesn't just go away overnight because we didn't get into it overnight. So, I think that it continues to be a high need and I don't see it changing. I really don't. I think if anything there needs to be more of a spotlight on mental health.

Are you, as a leader at Emtiro, thinking forward about how the pandemic is going to impact care delivery for your organization over the next 5-10-15 years?

Absolutely, because I think when you talk mental health, your body responds to that as well. So you know you could see such things as you never had high blood pressure before but now you do. Well was it anxiety driven? Is it just behavioral driven? So I think that with the younger population we're seeing now, they're going to have a lot more when it comes to medical conditions as they continue to get older. We just have to be ready. You know we have to be ready to provide those resources to them, educate them, get them set up with the providers and whatever that they need in order to manage that, but I also think with mental health and even with children, education is also key. You know there's a lot of unknowns, so I think when you provide that education and let them know that you do care you know you're not just providing them education to you know provide it to them you are truly caring about what happens to them, that is a key driver in the future of healthcare in general.

What do you see as the future for community health within the healthcare system and do you feel there is a need for a shift in healthcare as a whole to compensate for these issues?

So, community health workers have emerged as key players in value-based care and a value-based care model because they're responsible for not only supporting patients and addressing social determinants of health and improving care coordination as a whole. I would honestly like to see more certified community health workers. So, making sure they receive that appropriate training and building that confidence, it's there, sometimes I just don't think people, especially community health workers know where to find it. So, you know I want to be an advocate for that and you know say here it is you know it's waiting on you. Because I think the more knowledge and education you have the more confidence you have in providing good patient care.

I would also like to see the increase in community resources available to patients and I believe it's a constant need to research and link more community resources to organizations so that patients can receive appropriate care. So, I do see the role of the community health worker expanding through healthcare. The work is being done but there's just not a title to it. So I think there's always room for improvement in healthcare, it's ever changing, nothing stays the same but I do see an increase in the role of a community health worker across all of healthcare organizations.

Outstanding! Kari Currie, thank you for joining us today on the Move to Value Podcast.

Thank you so much. Have a great day.