“Coming Together, Cultivating Health for All” is the theme for the 2018 Learning Days event, which takes place April 3-4, 2018 at the Continuing Education and Conference Center at the University of Minnesota’s St. Paul campus.  Registration information will be available in January 2018.

In Minnesota and across the United States, community health workers (CHWs) constitute an emerging health profession with deep community roots. They apply their personal attributes, training and shared life experience with the communities they serve to carry out a variety of roles to advance health equity and the Triple Aim. According to the Minnesota Community Health Worker Alliance, CHWs come from the communities they serve, building trust and vital relationships.

United Family Medicine in St. Paul has included CHWs in their Advocacy Department for many years. They provide services such as outreach, patient education, language interpretation, and referrals, and are certified MNsure navigators.

CHWs need to know or learn the area they work in.  The neighborhood, the people, the community, the resources.  Anyone can give patients a list of resources but communication face to face and individually helping them is what people need and want.  Patients don’t always want to speak to a professional, sometimes they just want to be heard by someone who can relate to them.  To be a CHW, an open mind and an open heart is needed. Angelica Diaz, Lead Patient Advocate, United Family Medicine

As noted on the Minnesota Department of Health (MDH) CHW website, the Minnesota CHW workforce reflects the many faces of our state. CHWs represent immigrant and refugee groups along with American Indian, African American, Latino, Caucasian, and deaf communities. CHWs do not typically provide clinical care or hold a license in another health-related profession, but they do serve as a bridge between clinical and community care.

Minnesota is a leader in the CHW field, including education and payment. First in the nation to develop and implement a statewide, standardized competency-based curriculum in higher education, Minnesota now has over 650 CHWs who have earned a post-secondary certificate in the nationally recognized model program. At this time, this foundational training is voluntary. CHWs may also be trained on the job or hold degrees from a community college.  Minnesota Health Care Programs (the state’s Medicaid program) covers diagnosis-related patient education and self-management services provided by clinically supervised CHW certificate holders.

According to a 2016 MDH report, “CHW Toolkit: A Guide for Employers,” there were as many as 2,000 paid and unpaid CHWs in Minnesota. CHWs work in many settings including primary care, and are valuable members of HCH teams, going by many titles such as patient navigators, care guides, outreach workers, care coordinators or patient advocates. Minnesota HCH clinics that conducted internal evaluations of their CHW pilots reported positive outcomes, such as reduction in unnecessary healthcare utilization and improved chronic disease measures.

In Worthington, Nobles County Community Services employs three CHWs.  One CHW works with public health programs including Women, Infants, and Children (WIC), Child and Teen Checkups, and oral health. Two CHWs carry out grant initiatives on hypertension management and diabetes prevention.  They receive referrals from primary care clinics, pharmacies and other organizations that identify clients who have uncontrolled hypertension or are at high risk for developing type 2 diabetes or diagnosed with pre-diabetes. CHWs accompany patients to clinic appointments and offer follow up on disease specific criteria. Since hiring the CHWs over three years ago, the agency has seen an increase in trust with the community they serve. The CHWs have helped to increase the cultural competency of agency employees, as well as increase general understanding of the populations they are serving. Populations that were once hesitant to come to the government center to apply and access services are now seeking out those services and calling upon the CHWs for assistance. CHWs are a part of various community groups and committees and have helped advocate for disparate populations.

Starting in 2018, HCH stakeholders will be able to access learning through an online Learning Management System (LMS).  The LMS will allow HCH stakeholders to register for e-learning courses, webinars, and Learning Days and to create a log of learning activities for HCH certification and CEU credits.

The LMS will roll out in January with Foundations of Health Care Homes Certification, a course consisting of 14 short modules that explain the HCH standards and requirements for certification.  HCH plans to introduce new courses on selected HCH topics throughout 2018.  Courses will be complemented by webinars featuring applied knowledge or case studies on related topics presented by HCH stakeholders to encourage peer-to-peer learning.  HCH will continue to offer webinars most months and experiment with shortening webinars from 60 to 45 minutes.

Watch your email for a new HCH online bulletin focusing on HCH learning activities.  Coming to you soon!

The Minnesota Department of Health (MDH) awarded a $100,000 oral health access grant to Unity Family Healthcare's Family Medical Center (FMC), a certified Health Care Home clinic, to expand the scope of its patient-centered care delivery model to address oral health needs through collaboration with Apple Tree Dental.  Other collaborating partners included South Country Health Alliance and Morrison County Public Health and Social Services.

Research shows that poor oral health leads to poor outcomes for individuals with chronic conditions such as diabetes and heart disease. The goal of this project was to increase the integration of oral health and primary care for underserved populations thereby making oral health care more accessible and achieving oral health equity and improved health outcomes.

Access to oral health is an issue for the Little Falls community due to limited providers, and for those on medical assistance, acceptance of their insurance.  Many patients were either travelling long distances to receive oral health services or not receiving care, which resulted in patients going to the Emergency Department for dental pain.  The partnership between FMC and Apple Tree Dental set out to increase availability of services by increasing referrals for oral health care - especially for coordinated care patients, to develop a process for bi-directional exchange of information between the primary care clinic and the dental clinic, and provide education about the mouth-body connection, prevention, and treatment during office visits.

Through the grant, FMC was able to expand their integrated care model to include dental team members from Apple Tree, and Apple Tree created an Outreach Clinic with three dental treatment chairs on FMC’s campus providing service two days a week.  Providers at FMC received training to deliver preventative dental service, and Apple Tree received medical information about patients to deliver better care.

There have been challenges, but ultimately the collaboration between FMC and Apple Tree and the increased accessibility of oral health care services have made it easier for FMC’s Health Care Home team to coordinate oral health care for their patients.

This project was part of a $45 million State Innovation Model (SIM) cooperative agreement, awarded to the Minnesota Departments of Health and Human Services in 2013 by The Center for Medicare and Medicaid Innovation (CMMI) to help implement the Minnesota Accountable Health Model.

A 2017 change to the Statewide Quality Reporting and Measurement System (SQRMS) law restricts MDH from requiring providers to use a vendor to administer or collect data to meet SQRMS requirements; therefore, MDH is removing this requirement from SQRMS.

Due to the change, clinics are not required to use a specific survey instrument or vendor for patient experience or submit data to SQRMS. However, HCH standards still require the clinic to measure performance and engage in a quality improvement process that focuses on patient assessment of the HCH. Recertification also requires the HCH clinic to demonstrate that they have measured, tracked, and analyzed at least one quality indicator of patient experience. The HCH program does not prescribe a specific survey tool or question(s) for assessment of patient experience.

Please consult with your assigned nurse planner for additional information.