Unique UNM-Molina Partnership Model Expanding
The UNM Health Sciences Center Office of Community Health is spearheading a unique statewide program to help some of the state’s sickest and most underserved residents receive access to cost-effective medical care. The program, which is being studied as a national model for medical care under Healthcare Reform Acts, uses local community health workers to help referred patients access the healthcare they need now while also aiding them in addressing social and economic barriers that could impact their family’s health in the future.
A recentJournal of Community Healtharticle showed how the program has demonstrated reduced cost, increased quality and greater use of primary care instead of ERs for primary care-sensitive conditions. Plans now are to roll the program out in more than more than half the counties in New Mexico and UNM has also been asked to lend its expertise to programs in other states across the country.
The program, Community Access to Resources and Education in New Mexico (CARE NM), works with a mission “to empower individuals for a healthier tomorrow.”
The CARE NM staff, community health workers known by UNM HSC as Client Support Assistants / Field Case Managers, is unique in that they are non-clinical personnel. They are also from the communities in which they serve and are members of the Community Health Workers of New Mexico organization.
The program is funded through a public-private collaboration between UNM HSC and Molina Healthcare of New Mexico, one of the leading Medicaid Managed Care organizations in the State.
“We know that the traditional healthcare system can only affect about 10-20% of what makes communities healthy. A greater health outcome would be realized if our health system could also create better jobs, housing and education, safer neighborhoods, access to healthier foods and adequate transportation. We believe community healthcare workers can help address these broader health determinants and enrich the type of healthcare being provided in New Mexico. They understand the healthcare barriers their neighbors are facing and they know of local resources that physicians and other healthcare professionals might not be aware of,” said Arthur Kaufman, M.D., Distinguished Professor of Family and Community Medicine and Vice-Chancellor for Community Health at the UNM Health Sciences Center.
As specially trained members of the community, CARE NM staff first makes sure that each CARE NM client is established with a primary care physician. Once that relationship is in place, they also educate clients on the best ways to manage non-emergent conditions such as the use of same day sick appointments with their primary care provider, locating accessible urgent care centers, or calling the statewide, 24/7 Nurse Advice Line .
CARE NM community health workers do not provide direct medical care, but help a client, through education, coordination of care and services, find the care they need and understand all the care that is being offered. A critical aspect of their work is to visit CARE NM clients in their homes. These home visits are where staff can both learn of barriers that are keeping a client from obtaining the best medical care while also educating the client on how to most efficiently access the healthcare system, while also assessing physical and emotional barriers that might be impacting patient care.
A community health worker may do anything and everything including finding transportation to a doctor’s appointment, assisting in obtaining durable medical equipment, or helping with community services to acquire food, housing or home repairs that directly affects the client’s health.
Together, the community health worker and client will prepare a health risk assessment and arrive at a plan for healthcare. Staff can also provide home-based education on diabetes and asthma management as well as educate parents on such topics as well baby check-ups, prenatal care and preventive care. When establishing a client with a primary care provider, the CARE NM staff will accompany the member to their first appointment, to assist and advocate for the client, and to ensure there is a good fit and a “warm hand-off” to the health care provider said Diane Johnson, Program Manager for CARE NM..
“Molina is now supporting the spread of the program, operating both in the Albuquerque metro area, Las Cruces and Deming to South Eastern New Mexico and rural areas around the state,” said Johnson.
" New workers are being recruited to serve Albuquerque, Santa Fe, Los Alamos, Torrance County and the I-25 corridor down to Socorro and Carlsbad which will serve the Carlsbad, Artesia, Lovington and Hobbs areas.”
Eugene Sun, M.D., M.B.A., Chief Medical Officer of Molina Healthcare of New Mexico, said “Community Health Workers clearly provide a valuable service for people to help them better understand their health care issues and to help them navigate the complex health care system to get the best primary care. Helping patients to access timely primary care services will prevent complications and lead to better patient outcomes at lower cost, as evidenced by the recent publication of our experience with CHWs in New Mexico in the Journal of Community Health. The program is so successful that we intend to roll it out statewide as soon as possible.”
Contact: Cindy Foster, 272-3322