California’s Community Health Workers, Promotores, and Representatives

California Health Care Foundation2023-05-04

Community health workers#CHWs#promotores#health care workforce#health workforce#health equity#health education#health promotion#community-based outreach#Medi-Cal#CalAIM

678 views|1 years ago

💫 Short Summary

The video segments discuss the vital role of community health workers and Promotores in California, especially during the COVID-19 pandemic. They address systemic racism, provide culturally competent care, and bridge the gap between communities and healthcare systems. Challenges include measuring workforce supply, job titles, and training programs. There is a push for expanding training programs, offering career growth opportunities, and ensuring economic equity for CHW/Ps. The state aims to increase the certified CHW/P workforce by 15,000 individuals, prioritize workforce diversity, and improve data collection for workforce planning. Overall, the focus is on achieving health equity, addressing disparities, and supporting the community health workforce.

✨ Highlights

📊 Transcript

✦

Community health workers' vital role in connecting underserved populations to healthcare services.

02:25

Community health workers played a crucial role during the COVID-19 pandemic by combating misinformation, promoting vaccinations, and saving lives.

The pandemic highlighted structural racism in the healthcare system, emphasizing the need to address and eliminate it.

There was a call to build a diverse health workforce that reflects California's population and is deeply connected to communities.

Despite financial challenges, there was a commitment to supporting and expanding the community health worker workforce.

✦

Engaging Medi-Cal managed care plans with community health workers and Promotores.

03:59

Emphasis on impactful work for Medi-Cal members through collaboration.

State support for community health workers during transition and growth.

Introduction to diverse services and unique identities of community health workers, Promotores, and community health representatives.

Addressing racism, xenophobia, discrimination, and trauma through the important role of this workforce in California.

✦

Community health workers and Promotores are essential in addressing systemic racism and providing culturally competent care in California.

08:17

They act as a bridge between communities and healthcare systems, particularly for non-English speakers.

The diverse workforce reflects the population they serve, fostering trust through shared experiences.

CHW/P/R interventions effectively manage chronic conditions like diabetes.

Research in California involving CHW/Ps in voluntary and paid roles yielded valuable insights through surveys and interviews with training programs, workers, and employers.

✦

Challenges in measuring the supply of community health workers/public health workers.

14:30

Undercounting by national and state sources complicates tracking of workforce.

Lack of licensing or certification body adds to difficulty in tracking job titles and overlapping roles.

COVID-19 pandemic increased demand for CHW/Ps, leading to changes in employment and roles.

CHW/Ps took on new responsibilities such as COVID vaccination outreach and combating misinformation, showcasing impact on vulnerable populations.

✦

Demand for Community Health Workers/Promotores (CHW/Ps) in clinical settings.

16:41

More clinics than hospitals employ CHW/Ps, with varying wages based on employer type.

CHW/P wages increased during the pandemic due to higher demand.

Hospitals and clinics plan to hire more CHW/Ps, with hospitals having higher hiring goals.

Educational requirements for CHW/Ps include a high school education, with additional degrees and training certificates often required by hospitals.

✦

Disparities in Community Health Worker/ Promotor de Salud (CHW/P) programs in California.

21:55

Training for CHW/Ps post-hire varies in length and structure, from module-style to overarching trainings.

Mixed opinions on the potential impact of the State Plan Amendment (SPA) for reimbursement of CHW/P activities, with concerns about barriers and over-medicalization.

CalAIM presents an opportunity for indirect billing of CHW/P services in California.

✦

Challenges in accessing CalAIM for CHW/P work include lack of infrastructure, ECM focus on case management, and funding concerns.

24:52

Employers interested in hiring more CHW/Ps but face sustainability and training issues.

Discrepancies in role advancement and growth for CHW/Ps between hospitals and clinics.

Recommendations include expanding training programs, providing subsidies for trainees, and offering career growth opportunities for CHW/Ps.

✦

Opportunities for improving data collection and training programs for community health workers in California.

29:11

California Health Workforce Commission recommends scaling CHW/P engagement through certification, training, and reimbursement.

State budget includes funds to add 15,000 new CHW/P/Rs to the workforce with a certification program initiated for participating providers.

Recommendations to integrate CHW/Ps as covered providers in Medi-Cal to enhance workforce planning accuracy.

Collaboration between DHCS and HCAI to improve data collection about the community health worker workforce.

✦

The importance of community health workers (CHW/P/R) in improving community health and resilience post-COVID-19.

35:27

CHWs bring expertise, wisdom, and connection to their communities, making them effective agents of change.

Their work as outreach workers and educators is seen as a vocation that requires both knowledge and heart.

CHWs carry values and legacy, contributing to creating health equity communities and instilling hope for a better future.

✦

Importance of hope in driving change and achieving health equity.

38:11

Community health workers provide patient-centered care and address social determinants of health.

The Transitions Clinic Network offers evidence-based care that improves quality of life and builds trust in healthcare systems.

Acknowledgment of barriers and biases faced by individuals with histories of incarceration, highlighting the effectiveness of community health workers from the same community.

Efforts to develop statewide standards for community health worker training programs.

✦

The California Pan-Ethnic Health Network aims to expand the certified community health worker workforce by 15,000 individuals by 2028.

41:46

Funds and stipends are being provided to support this goal and address health disparities in low-income communities, especially among Medi-Cal beneficiaries.

Community health workers are viewed as essential in overcoming institutional and structural barriers in healthcare delivery systems.

The organization prioritizes community cultural wealth, values diversity in the workforce, and strives for equitable health outcomes.

✦

Importance of Community Health Workers (CHW) in Addressing Health Inequities.

45:57

Speaker shares personal experience as a Filipino community health worker in LA, highlighting family involvement in healthcare.

Transformation observed in individuals from passivity to taking control of their health.

Health Net representative discusses organization's goal of improving community health through trust.

CHWs play a key role in bridging gaps between communities and healthcare systems.

✦

California policy changes in healthcare benefits and workforce development.

50:42

Ensuring equitable access to benefits and addressing challenges in implementation are key concerns.

Partnerships with community organizations are emphasized for support and development within the healthcare system.

Financial struggles of healthcare workers are highlighted, stressing the importance of fair payment mechanisms for economic equity.

✦

Challenges of fee for service model for community health workers and the need for economic equity.

54:02

Limitations in billing for Medi-Cal highlighted as a barrier to providing services.

Importance of aligning training programs with the Department of Healthcare Services to enable billing for services.

California becomes the first state to approve Medicaid services for young adults in correctional facilities.

Positive outcomes observed when community health workers assist in transitioning individuals from incarceration to the community, leading to improved service utilization rates.

✦

The importance of community involvement in California's health equity efforts.

57:05

Empowering community health workers with career pathways and a living wage.

Policy support needed for sustainability.

Potential for community health workers to amplify the work of other organizations.

Importance of listening to experienced CHWs and aligning with community values for equitable system.

✦

Importance of economic equity and security in the workforce.

01:01:15

Advocating for thriving wages, benefits, and professional development for workers.

Highlighting the need for mental health support, workforce development, and culturally tailored resources.

Community health workers seeking involvement in defining their work, certification processes, and career pathways.

Call for more investment and respect for the profession, including stipend trainings to bridge the gap between healthcare providers and community members for better access to services.

✦

Importance of healing for healers and economic equity for community health workers.

01:04:27

Economic equity includes financial security and the ability to thrive personally and professionally.

Self-care is crucial for community health workers to live their best lives.

Appropriate supervision is necessary for managing vicarious trauma and boundary issues.

Therapy involvement and teaching of secondary resilience are significant in addressing secondary trauma.

✦

Importance of Supervision in Supporting Promotores.

01:08:18

Panelists stress the intentional approach in training and certification processes to avoid barriers based on immigration status.

Goal to certify 15,000 new community health workers, including existing workers through a legacy pathway.

Equity goal is to maintain diversity and language concordance within the workforce.

Emphasis on inclusivity and support for existing and new workers in the field.

✦

Health Net's training of Promotores since 2011 has shown that 70% of members are eligible for CHW support.

01:12:41

The importance of not overmedicalizing social justice movements when integrating them into healthcare is emphasized.

Lack of comprehensive data on service lines in California hospitals is discussed, highlighting the value of geographical analysis.

A survey on CHW/P employment in California by a large employer is mentioned, with data categorized by region.

Gaps in serving the prenatal to five population are addressed, emphasizing the need for workforce investment.

✦

Funding and Plans for Community Health Worker Programs

01:16:41

Budget allocations and stakeholder engagement are key components in the discussion on funding for community health worker programs.

Delays in issuing training funds are impacting program implementation and resource distribution.

Emphasis is placed on cultural congruence in training programs and grants provided for CHWs.

Consideration is given to existing community workers who do not identify as CHWs and the need to support their work.

Questions are raised about assessing the demand for CHWs in different settings and populations to guide future program development.

✦

The need for more Community Health Workers (CHWs) is evident in San Diego County.

01:20:55

San Diego County estimates over 7,000 CHWs are required, but only 4,000 are currently available.

There is a call for advanced training opportunities and career ladders for CHWs to support public health initiatives.

Regional efforts in Alameda, San Diego, Riverside, San Bernardino, and the Central Coast are focused on scaling the CHW workforce by analyzing supply and demand.

Collaboration and collective action with CHWs at the forefront are crucial for addressing health equity and disparities.

✦

Potential for health equity and economic development within BIPOC workforce.

01:24:36

Importance of upskilling individuals for various professions to increase black and Latino providers.

Significance of workforce equity and accountability in program development.

Call to action for public health to drive policy changes towards equity.

Emphasis on the need for community health workers to thrive and remove bias from policies.

00:05- Good afternoon, everybody.

00:06Thank you for your patience and thank you for your patience

00:09for folks that are joining us online,

00:12taking us a few minutes to get folks gathered here today

00:15on this Friday afternoon.

00:17My name is Kara Carter.

00:19For those of you I don't know,

00:20I am the Senior Vice President for Strategy and Programs

00:23at the California Healthcare Foundation,

00:24and I am thrilled to welcome you all this afternoon.

00:28This is actually only our second in-person briefing

00:31since COVID-19 restrictions began.

00:34I'm so grateful that we're able

00:36to have the opportunity to gather like this,

00:38and I'm grateful for you all for coming in

00:40on what is in fact

00:41an absolutely gorgeous Friday afternoon in Sacramento.

00:46The California Healthcare Foundation

00:47is an independent nonprofit philanthropy,

00:50and we work to improve the healthcare system to make sure

00:52that all Californians have the care that they need.

00:55We focus particularly on making sure the system works

00:59for Californians with low incomes

01:00and for communities who have been historically

01:02to face the biggest barriers to care.

01:06Our headquarters are in Oakland.

01:08We have an office here in Sacramento,

01:10and we have a number of colleagues that work

01:11in the southern part of the state.

01:15Today's convening is one of a regular series of briefings

01:18that are in-person and their virtual that we sponsor here

01:21in Sacramento for Sacramento policy staff

01:23and other folks that are interested.

01:26These briefings have two purposes.

01:27So they're designed first off to bring you the information

01:30that is relevant to healthcare issues and trends,

01:33and secondly, to promote dialogue on potential solutions

01:36to the challenges the state faces.

01:39In addition to the folks in the room,

01:40there are over 450 people on our Zoom today.

01:45We're excited to welcome both our in-person colleagues

01:48and our remote colleagues.

01:50And for folks who are curious,

01:51we will make a video of today's briefing available so people

01:54who aren't available today were able to watch it later.

01:58Our briefing today is about a key part

02:00of the health workforce in California,

02:02our community health workers and Promotores

02:04and community health representatives.

02:07My colleague Carlina Hansen will take the stage

02:09in a few minutes and she'll talk more about that.

02:11But these workers have a long

02:13and incredibly critical history

02:15in supporting our communities.

02:17They often serve as a critical bridge connecting people

02:20who are not well served by traditional healthcare system

02:22to the services that they need.

02:25During the COVID-19 pandemic,

02:27they were heroes on the front lines.

02:30They combated misinformation, they connected people

02:33to the supports they needed to survive,

02:35they promoted vaccinations and they helped save lives.

02:39The pandemic's disproportionate effects on people of color,

02:42particularly Latino and black Californians,

02:44laid bare the structural racism

02:46that has long existed and permeated our healthcare system.

02:49It is our collective responsibility to now uproot

02:52and eliminate that racism.

02:58Part of this work is ensuring

03:00that we're building a health workforce

03:01that reflects the rich diversity

03:02of the California population

03:04and is deeply connected to the communities we all live in.

03:08Community health workers and Promotores

03:10and community health representatives have a vital role

03:12to play in creating a modern healthcare workforce.

03:16We were very encouraged by the commitment to expanding

03:19and supporting this workforce in last year's state budget.

03:22While California's financial situation has changed,

03:25the need for community health workers, Promotores,

03:28and community health representatives

03:29is greater than it has ever been.

03:32They've been serving California communities for decades,

03:35and now it's time for us to serve them better.

03:38How do we ensure that this is a workforce

03:40that is well compensated, fully respected,

03:43and given the opportunities to advance in their careers?

03:47How do we rapidly expand this workforce

03:49without over medicalizing it

03:51or diluting their connection to community?

03:53How can we help new partners

03:55like Medi-Cal managed care plans engage

03:57with community health workers and Promotores

03:59in a way that is mutually beneficial and respectful?

04:03How do we ensure that all of this work

04:05is ultimately impactful for Medi-Cal members

04:07who we put at the center of everything that we do?

04:10And what is the role and the responsibility of the state has

04:13in growing and supporting this workforce

04:15through this time of transition and growth?

04:19I couldn't be more thrilled to bring together today a series

04:22of distinguished researchers and speakers

04:24to have this conversation on our panel,

04:26and I hope that you'll all enjoy it

04:27as much as I know I will.

04:30Carlina Hansen, a Senior Program Officer

04:31at CHCF leads the foundation's work

04:33around the community connected workforce.

04:35She's going to kick us off in a few minutes

04:37with a short overview on introductions,

04:39and then she'll serve as a moderator

04:40of the panel discussion.

04:42There'll be plenty of time for Q and A following the panel.

04:45Before I hand to Carlina, I have a few housekeeping items

04:48that I've been asked to kind of convey.

04:50The first is around questions.

04:53If you have a question,

04:54and we very much hope you have many questions,

04:56and you're sitting here in the room with us,

04:58please save those questions to ask during Q and A.

05:01We'll have mics circulating for them at the time.

05:04If you're joining us on Zoom,

05:05please submit a question at any time

05:07by clicking on the Q and A icon.

05:09Use the chat function for technical issues only.

05:13This session is being recorded,

05:15so the recording will be available

05:16on the CHCF website early next week.

05:19You'll receive an email with a link once it is available.

05:22And finally, for those of you on Zoom,

05:24we have both captioning in English and in Spanish,

05:27as well as translation to Spanish.

05:29Please check the Zoom chat for instructions

05:31on how to access those options.

05:33Now, please join me in welcoming Carlina

05:35to the platform, thank you. (audience applauding)

05:43- Hi, everyone, thank you so much for joining us today.

05:47I want to just thank Kara for the introduction.

05:51I'm very excited to be here with you in person.

05:54I have to say a teeny bit anxious to be away

05:56from the safety of my own living room,

05:59but I am definitely sure that my dog

06:02will not bark when the doorbell rings,

06:04so that gives me a little bit of confidence.

06:08So I am thrilled to be able to talk to you today

06:12about the community health worker workforce.

06:15Kara has gone over the housekeeping items.

06:18So just who are community health workers,

06:21Promotores and representatives?

06:23As Kara said, they are community members

06:26who offer a wide array of health and public health services

06:30and have been doing so since the 1970s,

06:33and some would say long before that.

06:36Those services can

06:37include providing culturally competent health services,

06:41health promotion and education,

06:44assistance in accessing medical and social services,

06:48care coordination, patient advocacy, and much, much more.

06:53You may also be wondering why the long acronym, CHW/P/Rs.

06:58It is because there are critical members of this workforce

07:01who have a unique identities and a long history

07:05of serving California's diverse communities.

07:09P stands for Promotores, who largely work in Latino, Latinx,

07:14and Spanish speaking communities,

07:16and the R stands for community health representatives

07:19who have long worked in American Indian

07:22and Alaska native communities.

07:26So I want to start by grounding us

07:28and sort of emphasizing some of the points that Kara made

07:31about why this workforce is important

07:34and what exactly is driving the increased attention

07:38by healthcare systems and policy makers in California.

07:42First and foremost, as we know,

07:45there are far too many people in California

07:48who have been impacted by racism, xenophobia,

07:52discrimination, and trauma, all of which of course

07:56can have a negative impact on their health.

07:59The systems that are designed to support Californians

08:02have work to do to dismantle systemic racism.

08:06CHW/P/Rs are part of the solution.

08:10It is however important to be clear

08:12when we talk about the workforce,

08:14that they are not responsible for solving the woes

08:17of systemic racism in the healthcare systems.

08:20They are part of a solution,

08:22a solution that all of us needs to be playing a part in.

08:28So evidence also tells us that shared identity

08:31can shape people's health experience and outcomes.

08:35We also know that shared language is important,

08:38all the more so because so many Californians choose

08:41to receive access to healthcare

08:43in languages other than English.

08:46Yet the demographics of California's health workforce

08:49does not match the population of the state,

08:52let alone the population of Medi-Cal.

08:55The CHW/P/R workforce is racially, ethnically,

08:59and linguistically diverse,

09:01and they often share other intersecting identities

09:05with those they serve, an experience of homelessness

09:10or incarceration or a shared identity

09:13around gender expression or socioeconomic status.

09:17These kinds of shared experiences build trust,

09:20which Kara talked about.

09:22CHW/P/Rs are bridge builders

09:25who support people's health and wellbeing.

09:30Additionally, as I think many of you know,

09:32the Department of Healthcare Services

09:33is encouraging health systems

09:36and Medi-Cal managed care plans

09:37to be more community connected,

09:40to reach out into the community,

09:42to meet people where they are,

09:44as opposed to waiting for them to come to us.

09:48CHW/P/Rs are an important part of this effort.

09:52Their work often happens in the community at health fairs,

09:57churches, homeless encampments, or community centers.

10:00This kind of outreach is important

10:02because it meets people on their own terms.

10:06Finally, CHW/P/R interventions work

10:09to help people controlling their diabetes

10:12or addressing chronic health conditions.

10:17So with that, I want to introduce our wonderful Jackie

10:23who is going to be presenting some of the research

10:25that CHCF has funded to reinforce some of the evidence

10:29that we know about CHW/P/Rs in the state of California,

10:34both from their perspective

10:35and their perspective of employers.

10:38Jackie, who's with the UCSF Health Force Center,

10:43has been a critical partner of ours in learning more,

10:47and I invite you to the stage, Jackie,

10:49thank you so much for joining us today.

10:52(audience applauding)

11:01- Thanks, Carlina, for the introduction,

11:03and thank you everyone so much for being here today.

11:06As Carlina has mentioned,

11:07I am here to discuss the recent research that we at UCSF

11:11have done about community health workers and Promotores.

11:17So I'll start by providing some general notes

11:19about our research study as a whole.

11:23First, the research focused on California only.

11:28Second, the research was informed by an advisory group,

11:33which represented seven different organizations,

11:36and these advisors really aided with survey development

11:40and interview guide development.

11:44Third is that the study population captured information

11:47about CHW/Ps who are both volunteering

11:51and in paid positions.

11:54So the initial goal of our project

11:56was to measure supply and demand of CHW/Ps

11:59but we experienced barriers to assessing supply,

12:02which I will discuss in a little bit more detail soon.

12:05The project comprised of four main components,

12:08which resulted in four main reports.

12:11First, we surveyed and interviewed CHW/P training

12:14and education programs across the state.

12:17Second, we surveyed CHW/Ps themselves.

12:20Third, we surveyed CHW/P employers and healthcare settings.

12:25And fourth, we interviewed CHW/P employers

12:28in a variety of settings.

12:30So today I'll be presenting highlights

12:32from all four reports,

12:33but the full reports can also be found on CHCF'S website,

12:37with the exception of the employer interview report,

12:39which will be finished soon.

12:45So first, I'd like to talk a little bit about CHW/P supply

12:48and why it's so difficult to measure.

12:50One of the reasons that we set out to measure supply

12:53is because we know that the national and state sources

12:56that count the workforce,

12:57like the Bureau of Labor Statistics,

13:00vastly undercount the number of CHW/Ps.

13:03Although there is an SOC code

13:05for the community health worker profession,

13:07the code does not capture all workers

13:09who perform the many different roles that CHW/Ps can have.

13:13Additionally, there are separate codes for different roles

13:16that can overlap with CHW/P work,

13:18such as health education specialists

13:21and mental health counselors.

13:25The workforce also lacks a licensing or certification body

13:28to track the workforce, which many other professions use

13:31to aid and measuring supply.

13:35Lastly, as many of you know,

13:36there are different job titles used to capture CHW/P work.

13:40Part of the reasons why there are many different job titles

13:44is because there are so many different roles

13:46that CHW/Ps can have.

13:48Oftentimes, they can focus on working

13:50with people with specific chronic health conditions

13:53such as diabetes or specific populations

13:55such as homeless individuals.

13:58Job title can also be affected by the type of organizations

14:01that CHW/Ps work for and their HR systems.

14:05And funding streams, especially if the role is grant funded,

14:08can also affect job title.

14:11Pictured on the right hand side

14:13is a word cloud that shows all of the different job titles

14:15that were reported on our CHW survey.

14:19And as you can see from the slide,

14:22community health outreach worker

14:24was the title that was most often used.

14:30So although supply was difficult to measure,

14:32we were able to get a better sense of CHW/P demand,

14:35and I'd like to start by saying

14:36that there has always been a need for CHW/Ps

14:39as they care for high need and vulnerable populations.

14:43However, the COVID-19 pandemic really highlighted this need

14:47and created additional workforce demand.

14:49Data from the CHW/P survey showed

14:52that one third of CHW/P said

14:54that their employment changed as a result of COVID-19,

14:58and of those respondents, nearly two thirds said

15:01that their employment change resulted in increased hours.

15:05Additionally, some healthcare employer interviewees

15:08commented on the COVID-19 impact on demand.

15:12For instance, one interviewee said,

15:14"I think COVID actually amplified the need for Promotores

15:18"because they were flexible and they took on a lot of roles

15:20"that were there before, and they have done amazing work."

15:29In addition to creating demand,

15:30the pandemic also changed the CHW/P role

15:33in some organizations.

15:35The chart on the previous slide showed

15:36that nearly one quarter of CHW/Ps

15:39who said that their employment changed

15:41as a result of COVID-19 listed an impact

15:44other than their hours changing.

15:46Examples of other impact that the workforce reported

15:49included shifting work responsibilities

15:52and taking on new roles.

15:55From the CBO perspective, one CHW/P interviewee explained

15:59how her role shifted during the pandemic,

16:01stating that, "Misinformation and myths travel very fast.

16:06"We're definitely seeing that with COVID.

16:08"And so we do a lot of community building,

16:11"a lot of trust building in the community.

16:13"For us, that's definitely our strength,

16:15"that we're able to go back to our community

16:17"and do a lot of unlearning,

16:19"making sure that we are up to date with the pandemic.

16:22"The information changes very rapidly."

16:25Some interviewees also noted other changes

16:28in the role as a result of the pandemic,

16:30including the need to provide COVID vaccination outreach,

16:33and that the pandemic created challenges

16:35with integrating the role into the clinical care team.

16:41We were able to quantify demand with data

16:43from the CHW/P healthcare employer survey.

16:47The pie chart show the number of survey respondents

16:49who said that they employed CHW/Ps.

16:52And as you can see,

16:53more clinic respondents employed CHW/Ps compared

16:56to hospital respondents,

16:57with nearly 80% of clinics saying that they employed them

17:01and 40% of hospitals saying that they employed them.

17:05It is also worth noting

17:07that CHW/P wages varied according to employer type.

17:11In general, hospitals paid higher wages compared to clinics.

17:15For entry level positions,

17:16most clinics paid between 16 and $20 per hour,

17:19while most hospitals paid between 21 to 25

17:23or 26 to $30 per hour.

17:26This trend also continued for senior level positions.

17:30For senior positions,

17:31most clinics reported paying between 21 to $25 per hour,

17:35and most hospitals reported paying

17:36at more than $30 per hour.

17:39Also, in some cases,

17:41CHW/P wages increased during the pandemic,

17:43partially as a result of increased demand.

17:51Clinic and hospital employers also reported

17:53on how many additional CHW/Ps they plan

17:56to hire in the next 12 months,

17:58as well as how many they would ideally hire

18:00in the next 12 months,

18:03as shown in the bar chart on the left.

18:05And as you can see,

18:06both hospitals and clinics anticipated hiring more CHW/Ps,

18:11but clinics anticipated hiring more than hospitals.

18:15Additionally, both hospitals

18:16and clinics wanted to hire more CHW/Ps.

18:20This was especially true of hospitals

18:22who would ideally hire more

18:23than 10 times the number of CHW/Ps than currently planned.

18:27Clinics would ideally hire more

18:29than three times CHW/Ps than planned.

18:35So now I'll discuss a little bit about educational

18:38and hiring requirements of CHW/Ps.

18:42The pie chart on the right show hospital

18:44and clinic educational requirements for CHW/Ps.

18:48And as you can see, most hospital

18:50and clinic employers required that CHW/Ps

18:53have a high school education at minimum.

18:55However, hospitals more often required an associate's

18:58or bachelor's degree,

19:00and sometimes a CHW/P training certificate.

19:06Clinics and hospitals also shared similar job requirements.

19:10The bar chart shows job requirement data

19:12as reported from the health employer survey.

19:16And as you can see, the job requirement most often reported

19:19for both clinics and hospitals was work experience.

19:23Other requirements most important to clinics

19:25were being bilingual

19:26and having a California driver's license.

19:29Other requirements most important to hospitals

19:31were having a California's driver's license, being bilingual

19:34and having completed CHW/P training.

19:38In thinking about hiring for this role,

19:40it is important to note that there are certain challenges

19:42associated with finding qualified CHW/Ps

19:45beyond having the appropriate level of education

19:48and meeting other job requirements.

19:50Some employer interviewees spoke

19:52about the challenges associated

19:54with finding qualified CHW/Ps.

19:56Specifically one interviewee said,

19:59"You don't just put this on LinkedIn or whatever,

20:01"or other job sites.

20:02"You have to take a different approach also in the hiring,

20:05"having community health workers on your hiring committee,

20:08"and also hire for some of those intangible qualities,

20:11"like passion and dedication to the community."

20:18Now, I'll transition to talk more

20:19about the CHW/P training programs that exist in the state.

20:25For the state with the largest population in the country,

20:28there are relatively few opportunities

20:30for CHW/P training programs for training in California.

20:35At the time of our research,

20:36we identified 25 active training programs in the state.

20:40On the right, you'll see a map

20:41of these training program locations,

20:43and as you can see, most of the programs

20:45are concentrated in the San Francisco Bay area

20:48or the greater LA area.

20:50This left large parts of the state,

20:52such as the North and Central Valley, without any programs.

20:56It is also worth noting

20:57that some programs were completely online

21:00or had online components.

21:02However, it is challenging to assess

21:04if these programs had the presence outside of

21:06or beyond their own communities.

21:11Most active programs offer general

21:13rather than specialized training.

21:15And when I say general training,

21:16I'm referring to programs that teach core CHW/P content

21:20that all or most CHW/Ps would or could use.

21:24This contrasts with specialized training,

21:25which I'm using to refer to programs that teach content

21:29that would be specific to a particular role,

21:31such as roles that might focus

21:33on a specific chronic condition or population.

21:38Although having CHW/P training was rarely listed

21:40as a hiring requirement among healthcare employers,

21:43all interviewees describe newly hired CHW/Ps

21:47undergoing training after they had been hired.

21:50Post-hire training varied in length significantly

21:53with a range to two hours to 16 months,

21:55the latter of which was an apprenticeship program.

21:58The structure of post-hire training also varied.

22:01Some organizations incorporated module style trainings,

22:05while others had one large overarching training.

22:08Some organizations created their trainings in-house,

22:11some contract with other education or training institutions

22:14and others participated in both.

22:17Many post-hire training courses

22:18also included a job shadow component.

22:24Now I will pivot to discuss some

22:26of the new billing mechanisms for CHW/P services.

22:30And first, I would like to discuss the State Plan Amendment

22:32or the SPA, which is often referred to as the CHW benefit

22:36or the DHCS benefit.

22:38The SPA became effective July 1st, 2022,

22:42and it provides reimbursement for some CHW/P activities,

22:45such as preventive services delivered

22:47in individual or group settings for certain issues

22:50such as the control

22:51and prevention of chronic health conditions

22:53or mental health conditions.

22:56These CHW/P services can take the form of health education,

23:00health navigation, screening, and assessment,

23:04or individual support and advocacy.

23:07More details on the SPA can also be found online.

23:11So in our study, we gathered data

23:13from employer interviewees about CHW/P billing,

23:16and I'd like to provide a small disclaimer

23:18about our findings.

23:20At the time of our interviews,

23:22the SPA had not been finalized and was thus incomplete.

23:25Although most interviewees were aware

23:27that the SPA was in development and generally understood

23:30that some types of organizations

23:31would soon be able to bill for CHW/P services,

23:35interviewees did not know which services would be covered

23:37or necessarily understand the mechanism for coverage.

23:41As a result, interviewee perceptions of the SPA,

23:44including who and what it was designed to cover,

23:47did not always accurately reflect the version

23:49that was approved.

23:53So our interviewees shared mixed opinions about the SPA.

23:57Some commented on their belief that the SPA

23:59could improve access to preventive care

24:01and potentially negate the need

24:02for organizations to demonstrate return on investment.

24:06Others feared that the SPA

24:07could potentially over medicalize the profession

24:09by excluding CHW/Ps who do not work in a clinical setting,

24:13and that the SPA could potentially

24:14require formal CHW/P education,

24:17which could create barriers for authentic CHW/Ps.

24:21Some interviewees were also curious to know

24:24if or how the SPA may tie into certain elements of CalAIM,

24:28such as enhanced care management.

24:34So CalAIM is another opportunity

24:37for more indirect billing of CHW/P services.

24:41The cost of services may be reimbursed

24:44through two main components,

24:45which are enhanced care management or community supports.

24:50Interviewees, however, reported potential challenges

24:52associated with accessing CalAIM to support CHW/P work.

24:57Some of these challenges included lack

24:59of organizational infrastructure

25:00to take advantage of ECM or community supports,

25:04ECM being too focused on case management

25:07or care coordination,

25:08which would not include other aspects of CHW/P work,

25:13and potentially the idea

25:14that there might not be enough funding in CalAIM

25:17to support the hiring of additional CHW/Ps,

25:21the fear being that it might only be able

25:23to support the existing workforce.

25:29So the reason why CHW/P billing

25:31is so important to think about right now

25:33is in terms of rural sustainability.

25:36Hospitals and clinics,

25:37but especially clinics were concerned

25:39with funding uncertainty for the CHW/P role.

25:44Other top concerns included finding qualified CHW/Ps

25:47or staff turnover, particularly for clinics.

25:52Almost half of hospitals indicated no concerns

25:54with sustainability compared to zero clinics,

25:57which is also an important note.

26:03Another aspect of CHW/P work that is important

26:06to consider is role advancement and growth.

26:09Role advancement is really important

26:11in terms of incentivizing CHW/Ps

26:13to enter or remain in the profession.

26:16And the pie chart on the left shows data

26:20from the CHW/P survey,

26:22while the bar chart on the right shows data

26:24from the CHW/P healthcare employer survey.

26:28As you can see, half of CHW/Ps reported

26:31that they had opportunities to advance.

26:33For the healthcare employer surveys,

26:35only 36% of hospitals reported

26:37that CHW/Ps had an opportunity to advance compared

26:42to 85% of clinics.

26:49So as I begin to wrap up today,

26:51I would like to leave everyone with a few key takeaways.

26:54First is that the COVID-19 pandemic highlighted the need

26:58and created demand for more CHW/Ps.

27:01Second, employers reported ideally wanting to hire

27:04between three to 10 times more CHW/Ps

27:06than currently planned.

27:08Third, there were relatively few training opportunities

27:11given the size of the state, especially in certain regions

27:15such as the far North and Central Valley.

27:18Fourth, interviewees expressed excitement

27:20about new mechanisms to bill for CHW/P services,

27:23but also some concern about implementation.

27:26And fifth, funding uncertainty was a top concern

27:29for hospital and clinic employers relative

27:32to CHW/P role sustainability.

27:37I would also like to provide everyone

27:39with some recommendations today.

27:41The left-hand column shows general recommendations

27:44that are applicable to many different audiences,

27:46the first set of which is applicable to training programs.

27:51Training programs have the opportunity

27:52to assist the workforce in several ways.

27:55First, they could expand new

27:57or existing training programs into new geographic areas.

28:01They could also provide subsidies

28:03or stipends for CHW/P trainees.

28:07Training programs also have the ability

28:09to do better follow up on their graduates,

28:12to find out where they're working

28:14or where they get placed with jobs.

28:17And also training programs can provide,

28:20there may be a space for more specialty training

28:22to assist folks, to assist CHW/Ps

28:26who want to focus on helping people with specific needs

28:33such as those with chronic health conditions

28:35or specific populations.

28:38Employers also have the ability to assist

28:41with the CHW/P workforce.

28:45They can provide higher wages

28:46or offer career growth opportunities.

28:49They can also incorporate sustainable funding practices

28:52into the role,

28:54which should include de-emphasizing the concept

28:57of return on investment, as it is difficult

29:00to attribute specific improvements to individuals' health

29:05to CHW/Ps when they're working in a team-based care setting.

29:10There are also opportunities

29:11for better data collection on the CHW/P workforce.

29:14And state and national associations have the ability

29:18to take the lead on collecting these data

29:21as they have a unique understanding

29:23and interconnectedness with the profession.

29:26There are also opportunities

29:27for the state to assist the workforce.

29:30The state can assist the training programs

29:32by providing funding for these programs,

29:34and they can also provide their own subsidies for trainees.

29:38There's also opportunities to assist with billing.

29:42The state could help with SPA implementation,

29:44especially for organizations

29:46that do not already have billing structures set in place.

29:49They can also ensure that CHW/Ps

29:51are a critical component of CalAIM.

29:54And lastly, the state can also assist

29:56with better collection of CHW/P data.

30:00They can improve the accuracy of CHW/P supply data

30:03to inform the state workforce planning,

30:06which could include emphasizing the use

30:08of the existing SOC code, regardless of employee job title.

30:13And lastly, DHCS and HCAI can work together

30:16to decide on which other data might be important

30:18to collect about the workforce.

30:22Here are the chart and quote sources

30:25for the presentation today.

30:28And I'd also like to thank the rest of our study team

30:30as well as the advisory group for their help with the study

30:35as they were integral to the success of the project.

30:39Thank you very much, everyone.

30:41(audience applauding)

30:49- Okay, I'm going to ask our panelists to come up please

30:52and take your seats.

30:56So a little bit of housekeeping before we get started.

31:01I want to call your attention to the blue evaluation form

31:04that you all should have received.

31:06Please do take a moment to fill this out before you leave

31:10because it helps us in planning these,

31:12making sure that we are being as responsive

31:14to your needs as possible.

31:16For the people that are online,

31:18you'll have an evaluation pop up towards the end

31:22of the session, so please do fill that out.

31:26I want to emphasize the slide that sits behind me just

31:30to share that there are, as I think many of you know,

31:34a number of policy changes

31:37that are happening in California right now.

31:41There is the, and much of it was seated

31:44by the California Health Workforce Commission in 2019,

31:48which recommended scaling the engagement

31:50of community health workers, Promotores and peer providers

31:54through certification, training, and reimbursement.

31:59In 2022, as we discussed,

32:01CHW/P/Rs became covered providers in Medi-Cal

32:05through an approved State Plan Amendment or SPA.

32:09Many CHW/P/Rs, as you just heard,

32:12are involved in the CalAIM program.

32:15The 2022, '23 state budget included funds

32:20to add 15,000 new CHW/P/Rs to the state's workforce

32:26in recognition of some of the other things

32:28that were going to stimulate demand in the state.

32:30And finally, in 2023, the budget also directed

32:35the Department of Healthcare Access and Information,

32:38or HCAI to initiate a certification program for CHW/P/Rs

32:43who are participating as Medi-Cal providers.

32:46So you'll hear a little bit more

32:48about these things as we talk on our panel today.

32:53With that, I would like to introduce our fabulous experts.

32:57Thank you so much for joining us.

32:58First we have Angelica Alvarez, who's the program director

33:03with El Sol Neighborhood Educational Center,

33:08Joseph Calderon, Joe Calderon,

33:10Senior Community Health Worker, Transitions Clinic Network,

33:15Elia Gallardo, who's the Chief Equity Officer

33:18and Deputy Director of Legislative and Governmental Affairs

33:23with HCAI, Andrea Mackey, who is the Policy Manager

33:29for California Pan-Ethnic Health Network, or CPEHN.

33:34And finally, Dr. Pooja Mittal,

33:37Chief Health Equity Officer with Health Net.

33:40Thank you all so much for joining us.

33:43Before we get going, I also want to acknowledge there

33:46are some fabulous experts in the room today

33:49who have a long history

33:50of doing amazing work supporting this workforce.

33:54We cannot have all of you up on the panel,

33:56but I want to make sure that we honor

33:59and thank you for all you have done

34:01to advance and support this workforce

34:03in the state of California.

34:05So I'm going to get started by asking our panelists

34:08to tell us a little bit about your organizations

34:11and specifically your work with community health workers,

34:15as well as one or two important things

34:19that you want everybody to know about the role

34:22that this workforce can play in improving the health

34:25of the people of California.

34:27So we'll start with you, Angelica.

34:29- First one, so everyone, can hear me, right?

34:33Good afternoon, everyone,

34:34I'm very glad to be here and pleased.

34:36My name is Angelica Alvarez.

34:38I work for El Sol Neighborhood Educational Center.

34:41El Sol is a nonprofit.

34:43We do work in San Bernardino County and Riverside County.

34:48We have been able to, during 35 years,

34:51we have been able to train, to provide technical assistance

34:55and to work with community health workers, Promotores, R.

35:00So, I have been working for El Sol for about 15 years.

35:06And I have the privilege to train,

35:09to work with community health workers, to supervise,

35:14to deliver programs with them

35:17in San Bernardino County, Riverside County.

35:19So something that I'm very glad to be here

35:21is because this is a time to recognize the work

35:24of the CHW/P/R, I'm very glad.

35:27As we know, after COVID-19,

35:30we have seen not only the struggle,

35:32but how our communities have been resilient

35:35through the work of community health workers

35:38and how we see the strengths that we have in our community.

35:42So something that I want to say

35:43and mention is that CHW/P/R, they're experts.

35:47So we know that they're experts.

35:49They bring a lot of expertise and wisdom

35:52when we bring them in the table.

35:54Also, I wanted to mention this phrase that I love

35:59from Harold Fleming.

36:00They say, "Because the wisdom of the community

36:02"always exceeded the knowledge of the experts."

36:06So that means that community health worker,

36:08they bring a lot of expertise

36:10and maybe more than some other people

36:14that have expertise other areas.

36:16Because why CHW/P/Rs are very effective?

36:20Because they live in the same communities

36:24and also they have gone through different struggles

36:26that the community go through.

36:28And also, the beauty part of this

36:30is that they are able to connect with the community

36:33in a way that they can make changes

36:34in their communities that they live.

36:37They build a strong relationships, but not only that,

36:39they go very deeper and they create those spaces

36:43that we can create dialogue, we can reflect,

36:48and we can really think about how can we solve whatever

36:51is happening in the community.

36:54The work of the CHW, they do different things.

36:58I mean, today, they're outreach workers.

37:02They educate, they provide education information.

37:05But more than that,

37:07in the years that I have been working for El Sol,

37:09I discovered that the CHW work is a vocation.

37:15It's something that they need to fill.

37:17It is we believe that we train brains and we recruit hearts.

37:21So it's a vocation.

37:23In the individual aspect, when we talk about that vocation,

37:28that vocation is infused with wisdom

37:31and life experience that they already have.

37:33And thinking about the big picture

37:36in the macro level is about hope.

37:39So how these CHW are bringing hope to our communities

37:43and how we can carry the values and the legacy

37:47in regards to the work that they do.

37:49Why we are here, because we want

37:51to transform our communities

37:52because we want to live in a health equity communities

37:57that can transform the work,

37:59that can transform our families

38:01and the communities that we are serving.

38:04I believe that without hope we cannot do anything.

38:08But the hope is the fuel

38:11for the struggle towards health equity.

38:13And I believe that we're here

38:15is because we believe in health equity

38:17and we're here because together,

38:18we can do it better and best. (audience applauding)

38:27- That was great.

38:29Quickly, you know, Transitions Clinic Network

38:31is a community-based program

38:33that provides primary care services

38:34to returning community members like myself coming home

38:38from prisons and jails, our program's patient-centered

38:41or would like to say person-centered approach

38:43that works closely with local organizations

38:45and community-based organizations to look at

38:48and address social services

38:50and the social determinants of health

38:52and acknowledging the competing priorities of reentry.

38:57And, you know, having walked those yards,

38:59healthcare's not something we speak about.

39:01So going back and teaching men and women about speak

39:04and the key ingredient to change being hope, you know,

39:07as my sister over here said, hope,

39:08hope is the key ingredient to change.

39:10And if we get hope out there, we can change, you know.

39:15Community health workers from the community they serve,

39:17build relationships that keep people in care,

39:20continuity of care, right?

39:21And with that continuity of care,

39:23the community health worker helps bridge the barriers

39:27and biases that hinder the people from healthcare.

39:30Education is great, a privilege,

39:35but lived experience can't be bought or taught, it's lived.

39:38And so, you know, let us acknowledge that as well.

39:41That's one thing I would love you to know

39:43about community health workers.

39:44I would also like you to know

39:45that Transitions Clinic Network's model is evidence-based.

39:49And in my experience, while we haven't studied this yet,

39:51but in my personal experience,

39:53has improved the quality of life

39:55while addressing a safe mistrust of systems.

39:58You know, thinking about, you know,

40:00everything that we've had to go through

40:01to get to where we're at today,

40:02saving tax dollars while creating jobs

40:05and empowering communities around healthcare.

40:08But we also have to acknowledge some of those barriers

40:10and biases might live in this room or might live in policy

40:14when we think about hiring men and women

40:16with histories of incarceration.

40:18But I can say without a doubt that regardless

40:21of the ECM population that's being served,

40:23when you have community health workers

40:25from the community they serve,

40:26it's almost common sense if sense was common,

40:29I'd argue it's not.

40:30But thank you, you know, it's a pleasure to be here

40:33and I thank, you know, CHCF

40:35for everything that they're doing for California.

40:37And I look forward to striving towards health equity

40:40in California and doing this correctly.

40:42So as California does, the nation will follow, thank you.

40:45(audience applauding) Sorry.

40:50That would be help break. - No problem.

40:53Again, Elia Gallardo with HCAI

40:56with the Healthcare Access and Information,

40:59Healthcare Information and Access.

41:02We, and at HCAI, we are actually tasked

41:04with creating a certificate program

41:06for community health workers, Promotores,

41:09representatives or CHW/P/Rs,

41:12that based on statewide standards.

41:14We're working to develop those statewide standards

41:16with a robust stakeholder engagement process,

41:20including community health workers, Promotores,

41:21and representatives themselves,

41:23we are really trying to capture that,

41:25that authentic voice of the community.

41:28We are also tasked with developing standards, again,

41:31in collaboration with the CHW/P/R stakeholders

41:34for training programs that provide the training

41:39that basically are based on the standards

41:41that are developed through community.

41:43I think Carlina already mentioned, we are also tasked

41:46with the expanding the certified community health worker,

41:50Promotores, representative taskforce

41:52or workforce by 15,000 individuals by the year 2028,

41:58and providing funds as well as stipends

42:00for community health workers, Promotores

42:02in order to make this a reality for us.

42:06The state is investing in this model,

42:08the community health worker, Promotores,

42:10representative model, because we see the value

42:12of the community health workers, we understand the outcomes.

42:16It's been shown multiple over the last decades,

42:21but really did come to the forefront

42:23with the COVID and the pandemic.

42:26In terms of community health workers,

42:28I wanted to talk a little bit about my personal experience

42:30and background with Promotores when I was working with

42:33and staffing Lideres Campesinas in California,

42:37which is a farm worker woman's leadership project.

42:40And, you know, because of a long history

42:43of many institutional and structural barriers

42:45that have created inequities

42:48for many low-income populations,

42:49including the Medi-Cal beneficiary community,

42:55that's resulted in tremendous health disparities

42:58throughout the Medi-Cal, throughout California,

43:02throughout low-income communities.

43:04And I just wanted to mention a couple

43:07of these dimensions or these barriers,

43:09the lack of healthcare professionals

43:12that come from the communities that we care for,

43:14and in particular that come

43:15from Medi-Cal beneficiary communities,

43:18the lack of trust within the healthcare delivery system.

43:20I think our two previous speakers

43:22spoke very eloquently about that.

43:25And they also did a wonderful job of talking

43:28about how community health workers, Promotores,

43:30representatives, how they bridge

43:32these challenging institutional and structural barriers

43:36that are faced by low-income communities

43:38because they themselves have faced those barriers.

43:41They themselves have advocated

43:42and figured out how to circumvent those barriers.

43:45So they're the perfect bridge for creating that connection

43:49between the healthcare delivery system, which again,

43:53does not, as everybody have said,

43:55does not absolve the healthcare delivery system

43:57of its responsibility of coming to the community.

44:00But it is one of those things that supports that connection.

44:05Thank you. (audience applauding)

44:09- Hello, hi, good afternoon.

44:12It's an exciting time to be here.

44:15I'm Andrea Mackey, she, her, hers, Policy Manager

44:18with the California Pan-Ethnic Health Network.

44:20And so CPEHN is, you know,

44:22a multicultural statewide health policy organization,

44:26you know, bridging and bringing together

44:29and mobilizing communities of color across the state

44:31to advance health equity.

44:32And so in particular,

44:35I help lead the Community Health Workers,

44:37Promotores and Representatives Coalition along

44:39with Joe over here from Transitions Clinic,

44:42Vision y Compromiso, the Children's Partnership,

44:45Latino Coalition for Healthy California,

44:47California Consortium for Urban Indian Health

44:50and Roots Community Clinic.

44:52So, you know, a bunch of us along with, you know,

44:54500 CHW/P/Rs, you know, health plans, you know, HCAI,

44:59most folks in the room, quite honestly,

45:01I think I've been on a Zoom call at some point with you all,

45:04you know, we've been coming together

45:05to make sure all that these policies coming down the line

45:08are rooted in CHW/P/R voices, you know,

45:11are financially sustainable,

45:13prioritize workforce diversity, you know,

45:16lead to equitable health outcomes.

45:18And at the end of the day,

45:19really value community cultural wealth, you know,

45:21the wisdom, the values,

45:23the stories that we have from our communities.

45:26And so a lot of, you know, this work

45:28and my mission to promote it all

45:30is, you know, rooted in my experience

45:31as a Filipino community health worker down in LA.

45:35You know, I used to screen for social determinants

45:37of health, provide diabetes education,

45:40provide resources to housing, food pantries, some people up

45:44with CalFresh, medication assistance.

45:47And I realized recently, actually,

45:49my mom and my Lola in the Philippines

45:51were Barangay Health Workers.

45:52So I'm guess I'm following a legacy here.

45:57And you know, what was always powerful

46:00is that you see people transform

46:01from really being passengers, you know, coming, crying,

46:04you know, their foot's getting amputated to being,

46:07you know, just drivers of their health.

46:09And so they're shifting positions.

46:12And so that energy and that spirit

46:14is what we bring into our coalition

46:15as all these policies come into play.

46:18And so, you know, Carlina, you mentioned, you know,

46:20the role of the CHW in California, you know,

46:23what does that look like?

46:24Well, the Children's Partnership really framed it for me.

46:28You know, we see our workforce as an anti-racist strategy

46:31because we're shifting power to folks who most, you know,

46:35directly experience the inequity, the conditions

46:39that cause the inequities in our health

46:41to being leaders in the field.

46:42So really excited to talk to you all today about, you know,

46:45shifting power, you know, having CHW/P/Rs

46:47at the forefront of our workforce.

46:49And with that, I'm going to pass it to you, Pooja, yeah.

46:53- Thank you for framing it. (audience applauding)

46:58It's a pleasure to be here today

46:59with this incredible group of leaders.

47:01I'm Pooja Mittal, I'm from Health Net.

47:03I'm their Chief Health Equity Officer.

47:05Health Net is a managed care organization.

47:07We serve about three million people in the state,

47:10two-thirds of whom are on Medi-Cal.

47:12And we have a footprint that's quite diverse

47:15across the entire state, so rural and urban,

47:18and in northern and in southern California

47:21as well as Central California.

47:23And I really appreciated what you just said around agency,

47:28because as a health plan, the goal of our organization

47:31is to improve the health of the communities

47:33and the people that we serve.

47:35And when we think about the difficulties in doing that,

47:39the biggest thing is trust, right?

47:41And progress only moves at the speed of trust.

47:44And that's what the CHW workforce and Promotores

47:48and the representatives bring to the healthcare system.

47:51They help to bridge that gap between the community

47:54and between providers, county organizations and health plans

47:59so that people can feel like they see themselves.

48:02And in doing so, they create agency in their own health.

48:06And the other piece that we think about

48:08is a real powerful piece that this workforce brings

48:15is the ability to actually meet people

48:17in the community where they are

48:19and actually reach the people

48:20who are currently unengaged, right?

48:23We have people who are engaged with the healthcare system

48:25and they don't necessarily get what they need,

48:27but there are an entire other group of people

48:28that are fully unengaged with the healthcare system.

48:31And so how can we use this culturally congruent workforce

48:35to go out into the community, meet people where they're at,

48:38and start to build those bridges again,

48:39and create that trust between the healthcare system

48:42and the community?

48:44And just to give you a little bit of background,

48:48I've had the privilege of working with Promotores

48:50since I was little, I grew up in Ventura County,

48:53did my residency in Ventura County,

48:55where I worked with Promotores there.

48:57And at San Francisco General,

48:59we had our Promotores coming into our clinics,

49:00doing oral health screenings for our kids.

49:03And they were often really successful in doing that work

49:06where we had very little access to dental care

49:09for our Medi-Cal patients.

49:11So, have a lot of respect for Promotores

49:14and really excited to be here

49:15to be talking to you all today.

49:18- Thank you so much. (audience applauding)

49:21I feel so far away from all of you.

49:24So there are, as we discussed in the introduction,

49:27several significant policy changes

49:29that are happening in the state of California.

49:31A couple of you touched on them

49:33that are happening right now.

49:35What else can you tell us about these changes

49:38and their potential impact in California?

49:41And this time, I'm going to switch it up

49:44and ask you to start, Dr. Mittal.

49:49- Thank you, we are really excited

49:53about this being a benefit and are excited

49:57to help be part of rolling it out.

50:00One of my concerns around this work

50:03is how do we really make sure that the benefit

50:06is being stood up equitably

50:08and in a way that's responsive to the community's needs.

50:12And we recently partnered with Vision y Compromiso,

50:15they did a survey of leaders

50:17in many of the CBO organizations

50:20that are traditionally doing this work.

50:22And what they found was that people are unsure

50:25whether they really want to participate

50:26in this work, those CBOs, right?

50:28They're not sure how the benefit is going to be stood up,

50:33if it's going to be consistent

50:35with the culture of their organizations

50:37and whether they'll be able to actually participate

50:41in a way that's equitable.

50:42And so I think that that's a really important flag

50:45for us to pay attention to.

50:47I also see a couple of other big challenges.

50:51One, as a health plan with a large footprint, we're required

50:55and wanting to set up a network across the entire state.

50:59And there are regions where there are not enough yet people

51:03to staff those regions,

51:05particularly in some of the rural areas.

51:07And so how can we make sure that we're not taking shortcuts

51:11and bringing in some of these companies necessarily

51:14that are sort of coming into the space new

51:16and really supporting these community organizations

51:19that have been doing this work for many, many years.

51:22And lastly, I think workforce

51:24is a really important piece of this conversation,

51:28and I think we'll talk about it a little bit more later,

51:31but thinking about

51:33how we can support standing up a workforce

51:36that then has the opportunity to grow

51:38and also have new opportunities within the healthcare system

51:41is going to be really important.

51:46- Thank you, yeah, I definitely want to echo, hello.

51:51Definitely want to echo all this, you know,

51:53like I said earlier, this is a really exciting opportunity

51:56where you're getting all these investments

51:57from the governor.

51:58We have the Medi-Cal benefit, you know,

52:01we're getting sustainable funding for the first time

52:03for our workforce, which could lead to economic equity,

52:07you know, in our communities across the board,

52:09we really see a community transformation model, you know.

52:13But however, you know,

52:14we're still facing some current challenges.

52:16We were talking, so with our coalition, you know,

52:18CHW/P/Rs and only 10% of folks were telling us

52:22that their current salary covers basic expenses.

52:25So 90% of folks are saying that, you know, with their job,

52:30you know, they can't make rent, provide, you know,

52:33pay for gas food, you know, just the basic.

52:35And so, you know, I've heard, you know,

52:39we do this out of service of the heart

52:40or, you know, the Bayanihan spirit, the community spirit,

52:42but the Bayanihan spirit

52:44doesn't pay the bills at the end of the day.

52:46So, you know, for this to really thrive,

52:48how do we ensure that we have a payment mechanism that,

52:51you know, equitably allows us to not only meet our,

52:55you know, just basic needs,

52:56but to have a living thriving wage?

52:58And so that's what a lot of the CHW/P/Rs

53:01have been telling us.

53:02And if you look at the benefit, you know,

53:04the fee for service model is $26 for 30 minutes

53:08for two hour max per beneficiary.

53:12You know, FQHCs cannot currently bill for this.

53:15And you know, you're not even building in, you know,

53:18what is the overhead cost, the administrative burdens

53:20that now clinics and community-based organizations

53:23have to undergo to have the infrastructure

53:25to be able to bill for Medi-Cal now.

53:27So, you know, if we're following along, you know,

53:30where we're currently at,

53:30we're going to just replicate the status quo

53:32that has not worked for our communities.

53:35Navigating, you know, systems of care that, you know,

53:37means your experience, delayed care or no care at all.

53:40Folks who don't look like you, you know,

53:42we don't need more of the same, you know.

53:44Joe always talks about we can't do the status quo.

53:46That's why we need to transform how we're shifting all this

53:50and really push for economic equity for our CHW/P/Rs.

53:53So real opportunity, but we have, you know, this pathway,

53:57you know, how are we going to move forward?

53:59And with that, I think I'm going to pass it.

54:02- Oh, thank you.

54:08I did want to mention that we've talked a little bit

54:10about how the commitment that was made last year

54:13for the health profession's workforce,

54:15the administration actually made billions of dollars

54:19of commitment to the health workforce,

54:20and the largest amount actually went

54:23to community health workers.

54:24So of that amount, there was a significant allocation,

54:27the largest of any other.

54:29So that should really reflect sort of the commitment

54:32that the state has to lifting up and being part

54:35of the change that we're hoping to see.

54:39And obviously it's a clear indication of how important the,

54:44and what value the state gives to this incredible workforce.

54:49In developing what we're going to be working on,

54:52which is developing a certificate program

54:54for community health workers, Promotores, representatives,

54:57what we're really looking at doing is making sure

54:59that we are aligning closely with our sibling organization

55:02and the Department of Healthcare Services

55:05to ensure that the training

55:07and the education that's received in any of the resources

55:11that we're able to allocate

55:12or any approved program that we look at,

55:15that those folks are coming out of that training

55:17and are going to be able to bill Medi-Cal

55:19for community health worker services.

55:21So we are closely aligning all the efforts that we're doing

55:25to make sure that that happens

55:26'cause for us, that is the avenue or the pathway

55:29to get reimbursed for these services.

55:31So we are working hard to make sure that we align

55:34and yet don't create any kind of unreasonable barrier

55:38to getting that certificate as a community health worker,

55:41a Promotores and a representative.

55:50- Well, first, you know,

55:53some of the work that we've been doing

55:54and talking about in California is being rewarded.

55:56And I want to give a shout out to DHCS

55:59because on January 26th, 2023,

56:02California became the first state in the nation

56:05to approve an offer for a set of Medicaid services

56:08for youth adults in state prisons, county jails

56:11and youth and correctional facilities for 90 days

56:13or three months prior to release.

56:15You know, doing this work in our sister clinic

56:18in Santa Clara County, prior to the CHWs going in

56:21and making contact,

56:2230% of the people showed up for services.

56:26After Santa Clara County Jail

56:29allowed the community health workers

56:30from the organization to actually go in, you know,

56:32roughly 90 days before to create a relationship

56:35and do a warm handoff, if you will,

56:38from incarceration to the community,

56:39allowing the community to play a part in it,

56:41that number went up to 70%.

56:44So, you know, thank you. (audience applauding)

56:46And I'm thinking about as California moves forward,

56:49and we're thinking about that 90 day in-reach,

56:52please, you know, everyone in the room that has a say so

56:54and what that looks like, community, community, community.

57:00Let that live in the community and let those resources

57:03and let us be a part of the solution.

57:05Let us play an active part.

57:08CalAIM and the CHW SPA, if done correctly,

57:11will be a step towards health equity in California,

57:13while empowering communities, providing jobs,

57:16and I'm hoping providing career pathways

57:18for community health workers, a living wage,

57:21respecting the profession, saving lives while saving money,

57:25and policy that can guarantee the sustainability

57:28of community health workers in California

57:31as California strives for health equity.

57:34- Wow, community, community, community.

57:36Yes, I mean, we're very excited about what is happening.

57:40This is a great opportunity.

57:42We believe that the community health workers peers

57:45have so much expertise that they can provide

57:49and amplify the work of other entities

57:51in regards to their policies, the system and environment.

57:54However, they have to be open

57:58so the CHW/PRS can provide that expertise,

58:01and also those organizations

58:02that have been working for many years.

58:05We believe that this is a powerful opportunity.

58:09However, what happen if those entities do not are flexible

58:15or open to listen to those organizations

58:18that have been working with the CHW?

58:19That's a huge problem.

58:21And the problem is because we believe that the CHW/P/R

58:25will have to adapt to a new culture.

58:27And what happen is that culture,

58:29if it will be far from the community,

58:32they will be less embedded in the community

58:34and the original team regards

58:37to be aligned with the community,

58:38work with the community, that will be far away.

58:40So I think if we do it right, if we invite those experts

58:46that have been working in the field for many years.

58:49I think this is a huge opportunity

58:51in regards to provide more resources for the community

58:56to amplify their voices and also to create a system

59:00that is held equitable for everyone.

59:05- Wow, thank you all so much, incredible and amazing work.

59:10So I'm going to ask one more of my questions

59:11and then I'm going to turn to some of the audience questions.

59:15And a really important part of the community health worker

59:17and Promotores workforce is the premise

59:20of nothing about us without us.

59:23The American Public Health Association

59:25encourages engaging CHW, Promotor

59:28and representative perspectives

59:30in policy related to the role.

59:32So several of you are or have been CHWs,

59:37I would love to hear just a little bit more

59:39about what you're hearing from the workforce right now.

59:42And why don't we start with you, Andrea, at the other end?

59:47- Yeah, so we've been talking to a lot of folks,

59:50training folks on, you know,

59:52who is Department of Healthcare Services, who's HCAI,

59:55even just walking them through how to pronounce HCAI.

59:59And so, you know, with our, you know, these trainings,

01:00:02you know, we've been hearing four main themes, you know,

01:00:04as we, you know, work towards integration.

01:00:07So folks are saying, you know, I have a lot of stats today,

01:00:10but you know, 60% of folks

01:00:12of the CHW/P/Rs we've been working with say,

01:00:14you know, the general public doesn't know what we do,

01:00:16who we are, and you know, how effective we are.

01:00:21And so a lot of it is, you know,

01:00:23how are we building up respect?

01:00:25How are we building up value, you know,

01:00:26valuing our workforce and giving folks decision making,

01:00:30not giving, but making sure we have decision making powers,

01:00:34being seen and heard, whether that be on the care team,

01:00:38whether that be in policy, you know, as we move forward?

01:00:43You know, again, I had mentioned before,

01:00:44economic equity is a key theme across the board.

01:00:47You know, folks are experiencing economic insecurity,

01:00:51you know, folks want a thriving wage, folks want, you know,

01:00:55benefits 'cause, you know, there's, we're either paying,

01:00:58you know, out of pocket for some curriculum for trainings,

01:01:03you know, for gas, you know,

01:01:04going back and forth to community members.

01:01:07And folks are saying, you know, this is a lot of work.

01:01:10Healers need healing too.

01:01:12Where are the mental health supports for us?

01:01:15And then, you know, in building up workforce development,

01:01:17you know, when we're talking

01:01:18about all these upcoming policy events,

01:01:21you know, how are we getting these paid trainings,

01:01:23whether that be for, you know, doing referral services

01:01:28or navigating, you know, these different outreach

01:01:30to COVID-19 to technology and resume support?

01:01:33People want more professional development

01:01:35to grow in their career.

01:01:37And then also just more development in, you know, policy.

01:01:41You know, all these events are coming to a forefront,

01:01:44you know, how are people are just going to be,

01:01:47someone was saying like,

01:01:48if we're not at the table, we're on the menu.

01:01:50And so, you know, how are we bringing in CHW/P/Rs

01:01:54to more of these conversations?

01:01:55You know, this is a great panel and a good example.

01:01:59And then with these benefits coming down the line, you know,

01:02:03we've been struggling to understand

01:02:04how are community members going to be able

01:02:06to access our services?

01:02:08You know, in particular folks were saying, you know,

01:02:10there's still a need to have more black CHW/P/Rs,

01:02:14more CHW/P/Rs in rural and agricultural areas.

01:02:17We need to really bridge, you know,

01:02:19the connection between hospital providers

01:02:24and folks on the ground and members to be able to, you know,

01:02:27get access to these services.

01:02:29And then do we have the materials and the resources

01:02:32for our community members that are culturally

01:02:34and linguistically tailored to what folks need?

01:02:37You know, is that ready there, is housing there?

01:02:38You know, I think we mentioned it.

01:02:40We're bridging the gap, but, you know,

01:02:43there's some structural issues

01:02:45that collectively we need to change.

01:02:47And so, you know, a lot of folks are in this

01:02:50and we're really excited.

01:02:51But, you know, again, this is an anti-racist strategy.

01:02:54So how are we pushing CHW/P/Rs to the forefront of this?

01:02:59- Thank you so much, Andrea.

01:03:01How about you, Joe?

01:03:05- Promise not to start chanting.

01:03:07You guys want to chant?

01:03:10You know, nothing about us without us.

01:03:15Nothing about us without us, you know.

01:03:17CHW/P/Rs want to a part of the process.

01:03:21We want to help define our work.

01:03:23We want to be a part of the certification process.

01:03:26We want to help, you know, in creating the career pathways.

01:03:29You know, CHW/P/Rs, you know,

01:03:31I'll try just not to repeat anything that Andrea said,

01:03:35but, you know, professional respect is what I hear

01:03:37when 60% of the community health workers

01:03:39of California say people don't know what we do.

01:03:43Because I've walked those shoes

01:03:45and I've been a community health worker, I know what we do.

01:03:48And if California and the nation knew what we do,

01:03:54there would definitely be more investment and more pathways.

01:03:58You know, more training is what we heard, you know,

01:04:00not less training.

01:04:01You know, we've had seasoned, you know,

01:04:03Promotores, community health workers come to us,

01:04:05you know, looking at the different numbers

01:04:07that are being thrown around and just going like, really?

01:04:09And I agree, you know,

01:04:11they're saying that our profession needs to be respected

01:04:15and invested in.

01:04:16And that includes stipend trainings and such.

01:04:19I'm going to say it again because, you know,

01:04:21it's just not happening as much as it should.

01:04:24Healers need healing too.

01:04:27A lot of us with lived experience, secondary trauma,

01:04:30et cetera, et cetera, healers need healing too.

01:04:33While we bridge those gaps and barriers and biases,

01:04:36you know, sometimes those scars open up, sometimes I bleed.

01:04:41Healers need healing too.

01:04:43You know, when we're talking about economic equity,

01:04:45you know, we recently had a policy committee,

01:04:47and I love the way it was defined.

01:04:49And let me read this really quick.

01:04:52"It refers to ability to be financially secure

01:04:55"and to thrive personally and professionally.

01:04:59"This is more than just the ability

01:05:00"to meet your basic needs,

01:05:02"but for you and your family to live your best lives.

01:05:05"An example of this might be the ability

01:05:07"to take your family on a vacation."

01:05:10Self-care, self-care, self-care.

01:05:13Can CHW/P/Rs get paid enough to live their own life,

01:05:17live their own best life?

01:05:19And you know, I think a lot of that comes

01:05:20from the meetings that we have.

01:05:22And I feel it's really important,

01:05:25blessed and grateful to be sitting here

01:05:27representing community health workers, P/Rs,

01:05:30and really everyone that falls under our umbrella

01:05:32when going on with the terms,

01:05:33who falls under those umbrellas today.

01:05:35Thinking about what California needs to do

01:05:38as we strive towards health equity.

01:05:40Without health equity,

01:05:42I question any of the other things

01:05:44that we've been given in the books.

01:05:48- Thank you, Joe.

01:05:50All right, you all, powerful words.

01:05:52Thank you so much.

01:05:54I have a lot of other questions,

01:05:56but I'm going to give some air time

01:05:58to some of our audience questions.

01:06:01So can you speak to your point, Joe,

01:06:05about the importance of appropriate supervision for CHWs

01:06:09and Promotores in managing vicarious trauma

01:06:13and boundary issues?

01:06:15I know TCN's done a lot of work around this,

01:06:18so maybe we'll start with you again, Joe.

01:06:21- I appreciate that.

01:06:22You know, in thinking about, you know, secondary trauma

01:06:24and what we, got me stuttering, secondary trauma (laughs),

01:06:30but thinking about the services we need,

01:06:31when I was originally hired with Transitions Clinic Network,

01:06:34we actually had our own therapist,

01:06:36which I thought was one of the best parts of the model

01:06:38because not only did the therapist have a working

01:06:41and we just like we could in our model,

01:06:44just like we can co-sign for our doctor and say, Hey man,

01:06:47that doctor's all right or whoever we're talking to,

01:06:49the people we're talking to, you know,

01:06:50regardless of he, she, they, we would tell them and cosign

01:06:54and that cosign bridges some of that mistrust.

01:06:58And so when I'm thinking about secondary trauma

01:07:00and those type of things, and healers need healing too,

01:07:03it would be lovely to see a system that's set up

01:07:06with the flow that actually has therapy involved,

01:07:09where you can actually do a check-in

01:07:10with who's on your caseload first

01:07:13and then how are you doing.

01:07:15With an understanding about secondary trauma, you know,

01:07:18there's also secondary resilience

01:07:21and teaching secondary resilience to the CHWs, Promotores

01:07:24and everybody else is out there

01:07:26to remember this work is hard

01:07:28and we're passionate, but it's necessary.

01:07:31I don't know if I answered, but I hope did.

01:07:32- Yeah, you did, thank you, Joe.

01:07:34And Angelica do you have anything to share?

01:07:37- Sure, I mean, in regards to supervision,

01:07:38I think the first thing that when I supervise

01:07:41is really understand the work of the CHW.

01:07:44Many of our supervisors, they have been Promotores.

01:07:47I mean, they have been doing the work in the field,

01:07:49they know the work,

01:07:51they know how to talk to the Promotor,

01:07:53they know in regards to boundaries,

01:07:54to safety, to confidentiality.

01:07:56So I think when I think about supervision,

01:07:59it's very important for the person

01:08:00to really understand the work

01:08:02and to really provide that support

01:08:05that the Promotor needs in that specific moment.

01:08:08- Great, thank you.

01:08:10Okay, so this is a tough one.

01:08:13How do we optimize this workforce

01:08:15without creating a two-tiered system

01:08:18based on immigration status?

01:08:21Some Promotores are hesitant to pursue new job opportunities

01:08:26because they don't have work authorization.

01:08:29How do we wrestle with this tension?

01:08:33We've got any brave panelists that want to take this one on?

01:08:36How about you, Elia? - I'm going to do a piece of it.

01:08:42I guess the thing that I would say

01:08:43is we've been very intentional

01:08:46in how we're crafting the training and the certificate

01:08:52as well as, to be honest, the community, the DHCS

01:08:54has been intentional with the benefit.

01:08:58There's never a request for information

01:09:01on any part of that for immigration status.

01:09:04So in order to receive a training,

01:09:07that's not going to be part of the process,

01:09:09in order to receive a certificate,

01:09:11that's not going to be a question on the application.

01:09:15And from what I understand, to serve,

01:09:21once you get the the CHW certificate,

01:09:23what it says is that you've been trained and you're eligible

01:09:27to provide services that can be reimbursed by Medi-Cal.

01:09:31So you know, we don't speak for employers,

01:09:34we can't do anything on the employer side,

01:09:37but we've been very intentional to make sure

01:09:40that we didn't create barriers on our end

01:09:44and the training end in terms of this population.

01:09:46So I don't think that's a satisfactory answer,

01:09:49but that's as far as we are able to go.

01:09:52- Thank you, Elia.

01:09:54And I think, you know, Joe,

01:09:55you mentioned earlier policy can be infused with bias

01:09:58and I think that it's a great example of where HCAI, DHCS

01:10:02have been really intentional

01:10:03about thinking about the potential barriers.

01:10:06We all know that there's a ways to go

01:10:08and there's other things that we have to circumvent

01:10:11and address, some of the much bigger picture issues

01:10:15like the one we're talking about now.

01:10:16But just I'm grateful to you all for the thoughtfulness

01:10:20with which you've gone through that process

01:10:22and for all the people that have participated in it.

01:10:28All right, let's see.

01:10:33So is the 15,000 CHWs, including current CHWs,

01:10:38including current CHWs, or is it new CHWs additional ones?

01:10:43And are there steps to retain CHWs

01:10:48in addition to bringing on new folks?

01:10:52- So the goal is

01:10:54to have 15,000 new certified community health workers,

01:10:59Promotores, representatives, so we

01:11:01are including the existing folks that we are reaching out to

01:11:04and trying to develop what we call our legacy pathway.

01:11:08Our legacy pathway is actually the place

01:11:10where we've gotten the most feedback

01:11:11because we are talking to existing Promotores

01:11:14who have been doing the work forever

01:11:16and basically don't need to go through a training

01:11:19to show that they can do what they've always been doing

01:11:21and doing very successfully throughout the years.

01:11:24So we're trying to create that pathway

01:11:26where folks like that can get the certificate

01:11:29to count for the existing workforce.

01:11:32The other workforce goal that we have,

01:11:33this is an equity goal that we have,

01:11:35not only for ourselves but for the secretary

01:11:38and the agency has for us,

01:11:39is we're trying to make sure

01:11:41that in developing a certificate program

01:11:44and developing our training program and pathway

01:11:46and developing our legacy pathway,

01:11:48that we retain the diversity

01:11:50of the existing community health worker workforce

01:11:54and that we retain the language concordance

01:11:57with the populations that they currently serve.

01:12:00So that is one of our goals is we want to make sure

01:12:02that in creating a, what I'm going to put in air quotes,

01:12:06a formal process, that that process does not take away

01:12:09from the equity aspects that everybody's been talking about

01:12:13on this panel. - Thank you, Elia.

01:12:17Go ahead, Pooja.

01:12:17- Can I just add one thing?

01:12:18I think another really important piece of that,

01:12:21so at Health Net we've had Promotores

01:12:23on staff actually since 2011.

01:12:25And as we think about broadening this benefit,

01:12:29actually when we look at our members,

01:12:32we estimate that 70% of them are eligible

01:12:35for CHW support, CHW/P/R support.

01:12:39And so as we train more people

01:12:41and bring them into this system,

01:12:45we need to be very clear

01:12:46about that over medicalization piece

01:12:48or like taking something

01:12:50that is actually a social justice movement

01:12:52and not over incorporating it into healthcare

01:12:55so that we change the essence of what the movement is about.

01:13:00- Thank you so much, Pooja.

01:13:02And that's powerful because Health Net's big

01:13:05and so 70% is a lot of people, so thank you for that.

01:13:10Okay, audience, do you have any questions for us?

01:13:14And also we have been asked to slow down the pace

01:13:16of our talk for our wonderful translators.

01:13:21So for the panelists,

01:13:22if you can slow down just a tad, that would be great.

01:13:26Yeah, I think we have mics. - Hi, Christina

01:13:33from the California Maternal Quality Care Collaborative.

01:13:36I'm incredibly interested in what data we have currently,

01:13:41specifically about hospital utilization

01:13:44of this important role.

01:13:47And I'm wondering if we have the data,

01:13:50have we dug into county

01:13:52or regional differences, service differences?

01:13:56I'm very interested in pregnancy,

01:13:59maternal birthing person care, so that,

01:14:01and then for-profit institutions

01:14:04versus not-for-profit institutions.

01:14:07And it just, thank you for your last comment, Pooja,

01:14:11'cause I think that was a really telling comment,

01:14:14but so I'd like to know what's up with the data.

01:14:18- Yeah, thank you.

01:14:20I think a lot of the things

01:14:21that you're talking about specifically in California,

01:14:24I am not aware that we have some of the deep data

01:14:27that you're looking for on service lines

01:14:29and things like that.

01:14:31But I'm wondering, Jackie,

01:14:32is there anything you want to add on the hospital perspective

01:14:35based on the survey that might speak to the question?

01:14:43- Yeah, I think that's a very good and important question.

01:14:47I would definitely recommend that you take a look

01:14:49at the report, the healthcare survey employer report,

01:14:52'cause that does have some data

01:14:54and statistics about employment of CHW/Ps

01:14:58in the hospital setting.

01:14:59But we didn't do a deep dive into the geographical regions

01:15:03that you mentioned, although I could definitely see

01:15:06the value add that would be there.

01:15:11- Can I maybe just put in a-_ - Yeah, please, Pooja.

01:15:13- So we just granted funding to HealthBegins

01:15:16and Joe behind you is the one that partnered

01:15:19with CPEHN and HCAI to do a large employer survey

01:15:24of who's employing CHW/Ps right now in the state.

01:15:27He's collating the data right now,

01:15:29so that's something that we'll release

01:15:30for everyone to be able to see.

01:15:32But he did break it down by region.

01:15:34So we have some data about regions

01:15:37and to your comment about pregnancy,

01:15:40we did ask about population served

01:15:42and I think that there is going to be a gap

01:15:45in people who are sort of serving

01:15:47that prenatal to five population.

01:15:49And so that's something that we'll have to think about

01:15:51as we invest in workforce.

01:15:53- Great, thanks, Pooja.

01:15:55- [Robin] Hi, my name is. - Oh, go ahead.

01:15:58- [Robin] My name is Robin Barron and I have a question

01:16:01about recruitment of black CHWs

01:16:06and also community health workers,

01:16:08Promotores in rural areas.

01:16:11I'm wondering if there's like any plan on how to do that

01:16:15and also funding for these programs

01:16:18to exist and continue running.

01:16:21- Yeah, great question.

01:16:23So I'm going to think there's two ways to look at this,

01:16:25maybe, Pooja, from Health Net's perspective

01:16:27as a rural provider,

01:16:28but also Elia to talk about a little bit about the status

01:16:32of the budget right now and where things are.

01:16:35So why don't we start with Elia this time?

01:16:38- Yeah, I get to do the status of the budget.

01:16:41So as I mentioned that the administration

01:16:44has made a huge commitment to community health workers

01:16:47in the amount of over $280 million.

01:16:52A pretty significant part of that, about 130 million,

01:16:56is still committed to the community health worker sector.

01:17:01It's being delayed to be issued out in later fiscal years,

01:17:06next fiscal year and the year after

01:17:07because of the current fiscal situation that we're in.

01:17:11And that is those exact training dollars

01:17:14that we are looking at to provide for training programs

01:17:17and stipends for community health workers.

01:17:19And obviously we're going to be looking very carefully

01:17:21at the disparities that have been identified

01:17:24through the research and that other partners are identifying

01:17:28so that we can look at the distribution of those dollars.

01:17:30We haven't even begun the stakeholder engagement process

01:17:33on that type of dialogue.

01:17:36For us, it's very important to make sure

01:17:37that we're checking in with stakeholders

01:17:40to have the dialogue to understand

01:17:42how all of this is going to look and the framework

01:17:46and ultimately how we're going to issue out those dollars.

01:17:48Because of the delay, we haven't started that dialogue yet,

01:17:51so we are looking forward

01:17:53to engaging all of you in that discussion.

01:17:56- Great, thank you.

01:17:59- I thank you for the question

01:18:00around the cultural congruence.

01:18:01And it's something that we are certainly thinking about,

01:18:04and not only for this benefit, but for the dual benefit,

01:18:07how are we looking at making sure that we have providers

01:18:11that are culturally congruent

01:18:12to serve everyone that we serve?

01:18:14And so that's something that we're looking at

01:18:16when we're investing in training programs

01:18:18and we just granted Vision y Compromiso and El Sol

01:18:25large grants to train several hundred CHW/Ps.

01:18:30And so that's a place to start.

01:18:33But as we get a better sense of where there's a need,

01:18:37what types of programs people are interested in,

01:18:41that'll help us to better understand

01:18:43and we are providing stipends for those

01:18:45because you have to pay people for their time.

01:18:49- Yeah, and I'll add just one thing to answer this question.

01:18:52I think one of the things we've heard anecdotally

01:18:54is that a lot of black CHWs

01:18:57don't necessarily identify as CHWs.

01:19:00They may be doing community work

01:19:02in churches, doing health education.

01:19:05And so I think there's also a question

01:19:07to be asked about like,

01:19:08who's out there already doing the work

01:19:11whose work can be surfaced and lifted up

01:19:14that may be able to benefit sort of the Californians

01:19:18and Medi-Cal beneficiaries that we're talking about today?

01:19:21So another question from the back of the room.

01:19:26- (laughs) Sure, thank you for letting me go first.

01:19:30Lisa Chanson with Transform Health.

01:19:32It's so great to hear everybody's comments, experiences,

01:19:37and it's such an exciting time.

01:19:38But I also want to point out that we've talked about CHWs

01:19:42in support of a lot of different populations

01:19:45as well as in a lot of different settings.

01:19:49And my question is around, you know,

01:19:53just adding to some of the questions around data

01:19:55and the different cuts of data.

01:19:58Has anyone done an assessment of all the different places

01:20:04that CHW/P/Rs, navigators, you know,

01:20:08whoever's out there that's doing this work

01:20:10is already operating, and what is the demand and the need?

01:20:15When we do our CalAIM work, we hear often from the field

01:20:18there are not enough CHWs,

01:20:21that providers are poaching from each other,

01:20:24that it's been a real challenge and then, you know,

01:20:27we're not always supporting the CHWs

01:20:30in a trauma informed way.

01:20:33And I remember San Diego County

01:20:36did a fairly in-depth assessment

01:20:39where they looked just in San Diego County

01:20:41and assessed how many of these types of workers

01:20:46are needed over the next 10 years.

01:20:48They currently have a little over 4,000

01:20:51and they estimated they need over 7,000

01:20:55of CHW/P/R navigator type workers to support public health,

01:21:01hospitals, clinics in community settings.

01:21:04And my question really is around,

01:21:07has anybody drilled down in terms of the data

01:21:11to look at what is the level of need in each of these arena

01:21:17and what is the type of potentially advanced trainings

01:21:21that could be provided?

01:21:22Are there ways to build career ladders

01:21:25and really lift up the individuals

01:21:28who are entering into this workforce into this space?

01:21:32I remember when we

01:21:33were running Sacramento Whole Person Care Pilot,

01:21:35CHWs were at the heart of our program

01:21:38and we had to really evolve

01:21:42and think about the different types of CHWs

01:21:45that we really needed

01:21:46to support the chronically homeless population

01:21:49in this county.

01:21:50We needed some that were in the aging space,

01:21:53we needed those who were previously incarcerated, homeless,

01:21:57who had a farm worker lived experience.

01:22:01And that was just in supporting the one population here

01:22:05in one county.

01:22:06So I wanted to lift that up, thank you.

01:22:09- Yeah, great, thank you so much, Lisa,

01:22:11and thanks for reflecting

01:22:12your Whole Person Care experiences.

01:22:15It's important for us to remember

01:22:16that there have been a lot of CHWs doing work

01:22:19in the Whole Person Care context

01:22:20for some time now prior to CalAIM.

01:22:24So I'll take a quick stab

01:22:27at your question about regionality.

01:22:29I think one of the things we're doing

01:22:31at the California Healthcare Foundation

01:22:33is supporting for regional collaboratives around the state

01:22:37and are looking to scale the workforce in those regions.

01:22:43And it's Alameda, San Diego, Riverside,

01:22:47San Bernardino working with El Sol

01:22:50and then the Central Coast.

01:22:51And part of what they're doing in those regions

01:22:54is looking at supply and demand.

01:22:56It was one of the things that we were looking at statewide,

01:22:59which we found extremely difficult to get to at scale.

01:23:03And so I think those kinds of regional efforts

01:23:05are really, really important.

01:23:07We did a webinar recently as part of that work

01:23:11to look at how you could quantify supply and demand

01:23:14in those regions.

01:23:15And so we'll have that posted on our website

01:23:17and I invite you to check it out.

01:23:21All right, how was our time? - Wrap time.

01:23:25- Wrap time, oh my God.

01:23:27Okay, so I just talked and it's our wrap time,

01:23:33so I want to invite each one of the panelists

01:23:36to just say maybe two words about your takeaways from today

01:23:42and what you want the audience

01:23:43to think about leaving this room and make it quick

01:23:46'cause we don't have much time.

01:23:51- Okay, it'll be two words,

01:23:54but I might have to give context.

01:23:55So I'm going to end with something that, you know,

01:23:58we end community organizing.

01:24:00In Tagalog, it's (speaks in foreign language).

01:24:02It means one down, one fall onto the next.

01:24:04So when one of us falls, we all fall,

01:24:06but when one of us rises, we all rise.

01:24:08And so looking at this panel,

01:24:09if we're all moving together collectively,

01:24:11we're going to be able to address health equity,

01:24:14we're going to address disparities.

01:24:15So, you know, if we do this collectively with CHW/P/Rs

01:24:19at the front, you know, one down onto the next,

01:24:22you know, we're going together, we're going to rise together.

01:24:25So (speaks in foreign language).

01:24:28(Carlina speaks in foreign language)

01:24:32- I have like a sentence, maybe one

01:24:34is I think we have a real opportunity

01:24:36around health equity here with this workforce

01:24:39and also we have the economic development opportunity

01:24:43for a whole entire new group of people

01:24:45that can build a pipeline for a BIPOC providers,

01:24:50nurses, MAs, like the whole thing.

01:24:53And part of what we're thinking

01:24:54about is how can we start earlier

01:24:56and really help people upskill

01:24:59and fill out all these other professions

01:25:02where we need more black and latino providers, so.

01:25:07- You went where I was going with workforce equity.

01:25:09We're obviously very interested in making sure

01:25:12that we are are providing a program

01:25:15that really does have that centered in the work that we do.

01:25:20And we're looking for your support in helping us make sure

01:25:22that you hold us accountable to making that happen.

01:25:25So please do participate

01:25:27in our stakeholder engagement process

01:25:28'cause we're still at the beginning stages.

01:25:30We haven't made any final decisions yet

01:25:33on anything that we're doing.

01:25:34So please do tell us how we're doing,

01:25:37tell us how to do it

01:25:38and ultimately weigh in on what we come out with, thank you.

01:25:44- Status quo has never helped my community

01:25:47and status quo has never been a spark of change.

01:25:50So let public health be the spark

01:25:52that addresses policies moving forward that serve people.

01:25:56Two words, no mas, equity now.

01:26:00- Beautiful, okay, so I will say

01:26:02that this is a great place to start.

01:26:05I think it's very important to recruit your CHW/P/Rs,

01:26:09to really think about the training and supervision

01:26:12that is very important to connect with those experts,

01:26:15that we don't have to embed the will,

01:26:18the will is already existing, we're doing the work.

01:26:21And also I have to take one phrase

01:26:24that Kara said this morning,

01:26:26that this is the time to serve them better.

01:26:28And I believe this is our time.

01:26:30- Thank you, so incredibly powerful.

01:26:34So I'll lift up a couple of things I heard from you all

01:26:36in addition to those magical words, this is a vocation,

01:26:41but people need to thrive.

01:26:44Remove bias from policy.

01:26:46The importance of CHW/P/R voice workforce

01:26:51is an anti-racist strategy and shifting power,

01:26:54unprecedented investment, but we've got work to do.

01:26:59Learn from the long term, learn from the agencies

01:27:02that have been doing this for a long time.

01:27:05Professional respect, it works.

01:27:09Healers need healing too.

01:27:11And this is about more than meeting basic needs.

01:27:15So with that, I want to thank our fabulous panelists

01:27:18for their wonderful words today.

01:27:20(audience applauding)

01:27:26And thank you to all the folks who helped

01:27:27to organize this fabulous event.

01:27:30I want to remind all of you to fill out your evaluation forms

01:27:35and please do grab a lunch if you haven't already.

01:27:38Thank you so, so much for joining us today, take care.

01:27:42(audience applauding)

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