Q&A: Dr. Paul Sherman, Chief Medical Officer at CHPW
Dr. Paul Sherman is the Chief Medical Officer at Community Health Plan of Washington (CHPW), the only not-for-profit Medicaid managed care plan in the state. In his role, Sherman is charged with providing direction and oversight over CHPW’s work to deliver accessible managed care services across Washington communities.
We recently caught up with Dr. Sherman for a conversation on CHPW’s vision for whole-person, community-based care, and an update on their work with Federally Qualified Health Centers (FQHCs).
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Emily Boerger: What is CHPW’s overarching mission when it comes to whole-person, community-based care?
Paul Sherman: “We really believe in the power of community and we believe that working on whole-person health in that context addresses the intersectionality of physical, dental, behavioral, and social determinants of health. And by addressing all of those together, whole-person care is how we achieve the best outcomes.
So, we utilize a lot of community-based supports to improve the health of our members, and we define community really broadly. There’s the community of health care providers, there’s the social service community, but we need to engage the whole community, the broader community. You know, churches, barber shops, and everybody in improving the fabric of the community and the health of all of our members.”
EB: It certainly seems like there has been a shift or a greater understanding in how important whole-person, community-based care is. Do you find that as well?
PS: “Absolutely. Across the spectrum, everybody is talking about it. But when you go out to the FQHCs in Washington State, you see that they are light-years ahead of everybody else in truly addressing it. Whether it’s really, truly integrating behavioral health, or many of them have dental clinics right on site which is far ahead of the commercial world. And they really bring it all together in a way that leads the way for the community. There’s a lot that all of the other providers in the state can learn from them.”
EB: Can you describe some of the other ways in FQHCs are leading the charge on whole-person care? Some specific examples?
PS: “I mean, every one of the FQHCs has a similar story, but Unity Care in Bellingham provides not only dental and integrated behavioral health under one roof, but to address whole person care they have group DBT therapy sessions for substance use disorder. They have group tai chi classes for substance use disorder (SUD), yoga for wellness and SUD, they have group acupuncture visits, because you know with acupuncture you’re often sitting there for a while, so they bring people in together so that it builds that sense of community and shared journey.
Another great example and it occurs up in Bellingham… this is really exciting, it’s a program that we brought up there to partner with Unity Care, Sea Mar, and PeaceHealth, and it’s called Veggie Rx. And we did the pilot this past year with members who had their hemoglobin A1cs for diabetes greater than 9 — which is the definition of being uncontrolled. And our case managers went up and helped develop a curriculum and helped teach classes to the members. They helped them go out and shop to help them make healthy choices, and provided them vouchers for fresh or frozen produce. And they’re still doing the evaluation, but it’s remarkable – about two-thirds of the people in the group brought their hemoglobin A1cs below 9. So, not out of control anymore. And in fact, 3 came off of their insulin altogether because they were managing it just with diet and exercise. So, really promising outcomes and we’re going to be expanding it this year.
Another really interesting partnership is with the Spokane School District. And they are one of the very few school districts in the entire country that is licensed as a behavioral health provider. So, we’re providing some community grants to help build out their program to address some really high-risk populations. Then we’re also working with them to understand how our regional office with our social workers and caseworkers can integrate with them, partner more closely with them to achieve better outcomes across the community.”
EB: Washington is so diverse depending on where you are at. How do these partnerships differ based on where they are located in the state? Are they tailor-made to the needs of the community?
PS: “Yes it is, and that’s what’s really exciting because obviously one size doesn’t fit all. And that’s one of the great things about partnering with the community because we want to bring resources and we want to bring partnership, but we don’t want to bring solutions that we’ve already designed. You need to listen to the community and understand what their needs are and what will work there. Even if the need is the same, what will actually work to address that need could be different in different communities. But, these stories are playing out across the state.
Another great example is Yakima Neighborhood Health Services which is involved in a consortium there where they have a big homeless problem, and they do many things to address their health needs such as having a mobile van to go out to the homeless camps to provide care. But they also work as part of a consortium that’s building permanent supportive housing. They’re in the process of rehabbing the old armory in Yakima to be permanent supportive housing for homeless vets, and Yakima Neighborhood Health Services is building a clinic to serve those vets in the armory.”
EB: I also wanted to talk about how health equity ties into this conversation.
PS: “Our patients, typically, are low-income and often from marginalized communities, and so we have always thought about how we interact with those communities. As I mentioned earlier, to interact with them in a way that gets their needs met. They have different traditions, different beliefs about medicine, different fears about interacting with powerful organizations, and so really understanding how we can best meet them to meet their needs. And really one of the most powerful ways to address inequities is just being in the community and really understanding their needs. It’s exciting to see this happening more across the country as people realize that just offering the same reminders, for example, to people who need diabetic screenings isn’t going to get rid of the disparities because sometimes the reminders, and systems, and ideas are built for middle-class white people and are going to be most effective with that group.
We think that the integrated care model that we do is also a key factor in addressing inequities because so often when you don’t have the entire picture of the patient, you can do what you think is right for their medical needs, but if they don’t have dental care, if they don’t have the ability to pay for prescriptions, if they don’t have community supports, then the medical care is not going to do them any good at all. By bringing everything together under one roof and supporting what is actually necessary to have the patient be able to engage in their health, is I think the most powerful tool to address inequities.”