Pilot partnership puts focus on community health workers

Dec. 2—MANKATO — A pilot project in Mankato aims to connect more clinic patients with community health workers, which its partners say could address the underlying social issues that negatively impact health outcomes.

Leaders from Mankato Clinic, Blue Cross Blue Shield of Minnesota and WellShare International highlighted the project during the opening keynote at this week's Rural Equity Summit. They spoke about their intention to build a sustainable community health worker model in the Mankato area before bringing it statewide.

The pilot involves identifying what social issues clinic patients are dealing with before assigning them to a community health worker to help them find local resources.

As Ceceli Polzin of Mankato Clinic put it during the keynote, "social determinants of health" play a big role in a person's well-being. And if much of a person's health outcomes are influenced by factors outside of clinical care, health care providers should have an interest in addressing them.

"If they're struggling with (social determinants of health), they're not going to be focusing on their own health, their own chronic disease," said Polzin, the clinic's community and customer relations manager. "What we're hoping is that if we can bridge that gap and help our patients with some of those barriers out in the community, they will have the capacity to start focusing on their health."

In other words, if a patient is struggling with language barriers or food insecurity, sticking to a treatment plan for their chronic illness isn't going to be their top priority. Having a community health worker help them find language assistance or food programs, the idea goes, should lead to better health outcomes down the line.

Mankato Clinic created a screening as part of the project asking every patient about their social determinants of health. It serves as a first step toward identifying what assistance a community health worker could offer.

It's a small pilot project at Mankato Clinic for now, said Maria Regan-Gonzalez, a population health design consultant with Blue Cross Blue Shield — she's also the mayor of Richfield. Plans are reportedly in the works to bring it to the rest of the state.

Regan-Gonzalez noted Minnesota has some of the worst racial inequities in the country, including health inequities, while talking about the need for investments in this project and similar models.

"We understand there is not an immediate (return on investment) in investing in that," she said. "We know it's going to take investing upfront without that return because we understand we're building a public health infrastructure. We're willing to take that financial risk on because we see the long-term gain."

Before the community health worker pilot, Mankato Clinic and Blue Cross Blue Shield looked into making the Mankato area into a "blue zone," a community wellness initiative promoting longer and healthier lives. A report they compiled in 2018 took stock of the community's health disparities, followed by Mankato Clinic leaders setting out to learn more about social determinants of health and health equity issues among their patient base, Polzin said.

Along with their findings about how large of a role social determinants have in health outcomes, they looked at demographic numbers showing Mankato was becoming more diverse. The findings led them to team up with Blue Cross Blue Shield on new screening processes for patients factoring in social determinants of health.

The blue zone idea was set aside in favor of the community health worker pilot. Mankato Clinic and Blue Cross Blue Shield invited WellShare in, recognizing the nonprofit had existing programs elsewhere using community health workers to connect with underserved populations.

Once Mankato Clinic identifies patients who could use a community health worker, WellShare receives a referral and a worker gets assigned. The worker reaches out to the patient to set up a meeting, learns their needs, then creates a care plan to be reviewed by a medical professional.

The worker can spend more time with a patient than what a doctor or nurse would have available. Later, the worker can give the patient a "warm hand-off" to local help on the issue they have.

Evan Curtin of WellShare gave transportation barriers as an example. The community health worker, he said, would work with the clinical team and clinical social workers to help the patient find options and explain the application process for assistance.

"The patient leaves that situation more educated and able to take on those issues in the future," he said. "It's not just a Band-Aid; it's a sustainable solution."

One of the issues he's seen with community health workers in the past is they end up being merely interpreters, or cultural consultants. Although it's a start and better than nothing, research he's seen indicates they should be utilized for more than that.

The key, he continued, is finding sustainable ways to offer and expand community health worker services. A claims-based billing system put in place by Blue Cross Blue Shield or other payors, for example, might work.

Their presentation ended with a call for additional payors to bring the model to other communities. Doing so, they argued, would reduce health inequities across Minnesota.

Follow Brian Arola @BrianArola