Episode 41: Community Health Workers & a Fond Farewell

Julie: This is BACON, brief ACO news from the MaineHealth Accountable Care Organization, a brined and cured monthly podcast for health care providers. I'm Julie Grosvenor.

Mike: And I'm Mike Clark. Julie and I are practicing physicians and liaisons with the MaineHealth ACO.

Julie: In this episode, we'll dive into the world of community health workers and learn how their presence in Maine will soon expand.

Mike: Yes, but first, we're going to say farewell to a close friend of this podcast.

Julie: Oh, that's right. Well, let's get right to it.

Mike: Well, today we're going to hijack the Meaty Topic segment for a brief goodbye. I am sad to say that after 41 episodes, my co-host Julie Grosvenor, MD, will be leaving BACON and MaineHealth for a whole new chapter in her career. This is incredibly sad for us, but exciting for her. Julie, congratulations.

Julie: Oh, thank you, Mike. I really appreciate that. This has been a tremendous journey with the ACO and has been a big part of my learning experience here. I have very much appreciated, you know, being a podcast star with you for 41 episodes. So thank you very much.

Mike: So I'm curious, you know, we've been doing this since the spring of 2019. I mean, pre-pandemic, a lifetime ago, right? We've covered dozens of topics related to the ACO, to value-based care. We've profiled a lot of our colleagues, and that's been really rewarding, and learned about a ton of really exciting work happening around health care and public health here in Maine. And I'm wondering if you want to take a second to reflect on things that we've heard together or that we've learned over the past couple of years that kind of stick out for you.

Julie: So yeah, I would say the thing that is most striking to me really is just the incredible complexity of making any of this happen. It seems like it should be so simple. We're just taking care of patients. We're all highly trained physicians and APPs. We know how to do it. But just everything about how to deliver and measure and monitor the care has become very complex. And I think what is striking to me is how much the ACO does to mitigate that for us. So, you know, as you're aware, each different insurer or governing body has hundreds of metrics they want reported. And the ACO has done a great job of working toward really distilling it down to the ones that matter the most, you know, the ones that matter the most, not just financially, but impacting our patients' care here in Maine and New Hampshire. So, I think it is really great sometimes to celebrate how much the ACO really is doing to make our lives simpler, even though they don't seem that simple most of the time. That's been my biggest takeaway.

Mike: That's great. I would so wholeheartedly agree with that, Julie. You know, being able to be a liaison and to be a podcast host has given us both a chance to sort of step away from our clinical roles and wear a different hat and anything that sticks out in that capacity that you have held. Anything that's been kind of your favorite parts of the liaison, physician liaison role?

Julie: Oh, yeah. Honestly, and unfortunately, most of this was pre-COVID, but my absolute favorite was literally just getting out into the communities, getting in front of practice groups and providers. The social events we used to host, where they would come and we could just talk about, you know, what's going on, what troubles are they having? What solutions have they found? You know, all in an effort to dig out the best ideas and the best solutions from wherever we could find them and hopefully spread them throughout the system. So I loved it when we could do that in person. And obviously, all of us miss everything we used to do in person. But even now, you know, I love hearing our segments we do with different provider groups and hearing the just amazing work that people are doing. Sometimes things that they dreamed up on their own, you know, and little teams of folks who are working together and figuring out just fantastic things that the rest of us could learn from. So I think, you know, the best thing about being a system is that you've got a lot of people working on the same problems and can come up with the best answers. And as a system, then it's our job to get that spread around.

Mike: Yes. Well stated. I'm curious, as you say goodbye to the podcast and move on, what is your hope for the BACON podcast as we regroup and move into the future without you?

Julie: Well, that is a great question. And I would say, despite the fact that I've just celebrated how much I think ACO is doing and how, you know, how much they work to simplify and break things down for the docs into the most important elements. And despite the fact that folks all through the system are already problem solving and we're trying to share that, the reality remains: providers are still struggling. You know, there's lots of burnout. There's lots of, you know, stress. There's lots of just feeling like you're beating your head against the same wall over and over again. And, you know, and we hear people say that. I think, from my perspective, the thing this podcast could do most effectively is be a place where providers can come bring us their tough questions. Why are we doing it this way? Why aren't we doing it that way? What are you doing about this or that? Bring those tough questions because we've got access to all the right people who can really hear it, talk through what we've done so far, and maybe even start to think up ideas for what to do next. So I would love to see more and more people interacting with the podcast in a way where they're bringing us their top issues that they want explored.

Mike: Hmm. That's brilliant. Thank you. It is a sad day for me, and I am grateful, so grateful for having gone on this journey together with you, Julie. And I just want to say thank you for being my collaborator and sounding board and the source of wit and wisdom, and also thank you for all your contributions to health care in Maine. We have been honored and have been well served with the care that you have brought, and we're going to miss you. It's a real loss for all of us. But again, congratulations. We're excited for you.

Julie: Well, you are so kind, Mike, and thank you as well. This has been really a fun, fun experience for me.

Julie: Welcome to The Sizzle. Our segment on ACO participants doing good work both inside and outside of work. This month, we fill up our virtual studio with a whole bevy of guests to talk about community health workers in Maine. Our producer, Paul Santomenna, will introduce them all.

Paul: I'm joined today by three representatives of the Preventive Medicine Enhancement for Maine Program, also known as PREVME. We have Dr. Renee Wolff, who is a consultant with the program. Also, Dr. Katie Sharp, who's an internal medicine physician who recently completed the Preventive Medicine Fellowship at MMC and Marin Johnson, who is director of prevention programs at PREVME. So welcome, everybody. I just wanted to start with the basics here. So tell us, what is a community health worker?

Renee: So a community health worker, as defined by the American Public Health Association, is a frontline public health worker who's a trusted member of the community. These trusted members of the community help people navigate complicated systems. They provide health education, health outreach, and connect people to the resources they need. They often work where people live, eat, work, and play, functioning as liaisons, cultural brokers, guides, advisors, and friends, and help combat racial and economic disparities that people face as they interact with health care systems. It's probably good to mention that what they are not is physician extenders or clinical providers. They are not unskilled. They often have various backgrounds, various degrees of education, but they receive specific training to help them with this role.

Paul: Oh, thanks, Renee. Just to give some context here, so we're talking about community health workers right now because there's an effort that you're all involved in to increase CHWs in Maine. So can you tell us about that?

Marin: So our pilot, our Community Informed Care Initiative pilot, is for, right now, the Greater Portland area. So we hired on Grace with some grant funding and we have more grant funding coming in to get two more CHWs for our Portland region. The way that we have structured our model is a way that we just want to be able to disseminate across the system to other local health systems, so they can duplicate the efforts in this way, of using the same kind of job descriptions and logic models and co production methods that we are developing and researching to make sure that it is an evidence-based program. What we were hoping, in terms of this community informed care initiative, is to bring CHWs into our system, to, A. Diversify our workforce and to employ community members that could be valuable to our patients and care teams, and to train them to help be that trusted member, to help the communication between the provider and the patient. Being able to document in Epic, so providers can see progress on their patients, and to allow that screening, those SDOH screenings, for real-time help. So if someone is scoring, you know, that they are food insecure from the SDOH flow sheet, then the CHW can help that patient, right then can get connected to local food pantries or emergency food banks. If a patient says that they can't get diapers, we can help them get connected to the diaper bank. And those are the things that providers and care teams don't necessarily have the time to do in that 20-minute visit.

Paul: So, Katie, I want to end with you and have you remind providers how they can work with CHWs, sort of the nuts and bolts of that. And if you could provide that information about the Epic inbox as well, that would be fantastic.

Katie: Yeah. So the first thing is to ask if your patient is interested in working with a community health worker, that option is available. And now we do have the referral through Epic, which would be an in-basket message to pull number 10364 named MMP, FMC, Portland CICICHW, if you have any questions about that, you can always reach out to either myself, Renee, Marin, any part of the preventative medicine team, and we'd be happy to connect you as well. There are also CHWs to be aware of in the community, so even just asking if someone is working with a CHW and letting them know that that resource is available, whether it be through MaineHealth or through the community, it can be really helpful for patients who might have barriers to health care. So, just connecting patients, getting them in touch with the CHW is really, I think, the first step.

Paul: Thanks. And we'll put that information about the message, the inbox message on our website as well, so people can refer to that.

Renee: This is Renee. I just wanted to add that we know that CHWs are here for the long term. They've been here for a long while. There are numbers of ways that community health workers are already involved in the greater Portland area and throughout the state. We further know that there is a lot of money coming into the state to look at how health care is delivered and to help. And some of that money is being directed towards community health worker programs. So we think that they will grow. We are hoping to learn from our experience with these community-based organizations and use the ideas of collaboration and co-production to create programs that can be models for the rest of the state. We've learned a lot from our Ask the Doc series, which is a community health worker-facilitated and run program. We've learned a lot from our Project Echo, which was also a community health worker, co-produced series on barriers to health. And we have incorporated what we've learned about relationship building and trust and the importance of having the community voice at the table into our Community Informed Care Initiative called CICI. Some of these changes are difficult. Bringing people in from communities to sit at the table is not always easy, but we feel it's necessary and we'll create more effective and efficient community engagement. We're happy to answer any questions. We can be reached through the Division of Preventive Medicine. And I think, as Katie said, you know, ask whether your patients are interested in having a CHW. Ask whether that CHW, whether you can waive HIPPA so that you can talk to the CHW, and make sure that you're up to date on your inherent bias training. I think those would be our recommendations.

Mike: Great. Well, thanks. Thanks, Renee and Katie, and Marin for sharing info about the work that you've done and will be done in the future.

Renee: Thank you.

Katie: Thank you.

Marin: Thank you very much for this opportunity.

Mike: Thanks for listening to BACON this month. You can find all our episodes on your podcast app and at our web page, MaineHealthACO.org/BACON. And if you have questions, comments or suggestions, we would love to hear from you. Please email us at bacon@mainehealth.org. That's bacon@mainehealth.org.

Julie: Bacon is produced by the MaineHealth Accountable Care Organization with help from MaineHealth Educational Services. Thanks for joining us and so long.

Mike: Bye-bye, Julie. We'll miss you and I'll see the rest of you next month.