Community health workers (CHWs) in Utah are one of the most effective ways to engage underserved folks to help address the social determinants of health (SDOH).
At our 2022 Utah State of Reform Health Policy Conference, three experts discussed the importance of CHWs, initiatives in Utah aiming to address SDOH, and the progress of those initiatives.
The panelists were Dulce Diez, Director of the Office of Health Disparities at the Utah Department of Health (DOH), Lisa Nichols, Community Health Assistant Vice President of Intermountain Healthcare, and Peter Weir, M.D., Executive Medical Director of Population Health at the University of Utah Health.
Nichols said that she is proud of the progress that Utah has made throughout the pandemic.
“Even three years ago when Dulce, Peter, and I did presentations like this, we spent a lot of time just educating people about what the social determinants of health were. I’m really proud today that we don’t actually have to do that anymore,” Nichols said.
The panelists’ main investment in the SDOH space is in CHWs and the relationships they build with community members.
Diez said DOH placed CHWs in COVID-19 testing sites to treat social issues as well as medical issues for as many people as possible. This includes asking questions to community members about their housing situation, food security, and overall safety. Once a need was identified, the CHWs would refer them to local, accessible resources for their specific need.
According to Diez, DOH was able to reach over six thousand people at these testing sites throughout the state.
If someone tested positive at one of these testing sites, contact tracing professionals would reach out to inform them of their positive result and ask them if they have any other social needs while experiencing COVID. This outreach referred 17,000 people to CHWs, and they were able to help over 7,000 people during this process.
Nichols continued to say how essential the work of CHWs is to expanding access to care. Throughout the pandemic, CHWs would reach out to members of SelectHealth—Intermountain’s Medicaid plan— digitally, to check in and make sure folks did not fall through the cracks.
For example, CHWs would call someone who recently missed their appointment. If that person said they had missed their appointment because they cannot afford to get their car fixed, CHWs would orchestrate transportation to get members to another appointment. She said this supported over 5,000 members.
Intermountain has also been working closely with two communities in Weber and Washington counties to see how digital referral platforms work in practice in an attempt to curb emergency department (ED) visits.
This process starts with social screenings in primary care offices. Based on a patient’s needs, the digital platform would transfer their information to referred specialists and/or behavioral health providers. This would create an automatic connection with CHWs and/or behavioral health providers. Nichols said Intermountain conducted over 20,000 screenings.
Weir spoke on the University’s efforts to address the social determinants of health in a new clinic called the intensive outpatient clinic (IOC). The IOC is the culmination of many different health professionals around the SDOH space into one clinic to help address the needs of the highest-cost Medicaid members in one space.
The IOC found a significant correlation in their patients. Patients with the highest need tend to all have childhood trauma. Weir said 90% of patients seen at the IOC had significant childhood and adulthood trauma, including physical, sexual, and emotional abuse.
“We didn’t open up a clinic and have a set of skills to have people come to us, we found people, we found their needs, and we oriented a clinic around them,” Weir said. “We hired people with the right culture and the right skill set to take care of those needs.”