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Delivering better medical care, at $15 an hour

Trained lay Community Health Worker (CHW) Mary White (left), from the Penn Center for Community Health Workers, partners with a patient at high risk for poor post-hospital outcomes. A new study in JAMA Internal Medicine reports that the Penn Center for Community Health Workers’ IMPaCT (Individualized Management for Patient-Centered Targets) intervention improved both patient experiences and health outcomes, while reducing repeat hospital readmissions.

Often, talk of effective medical innovation means something high-tech and high price, but a report out today in the Journal of the American Medical Association highlights one that's anything but: The low-tech, low-price lay community health worker.

For about $15 an hour, community health workers are doing what much better paid doctors, nurses and social workers struggle to do: keep sick patients from returning to the hospital again and again.

To understand what a community health worker does, let’s talk about a real case -- a woman who kept showing up to the hospital with high blood pressure, a little overweight, complaining of chest pain.

"Automatically, people worry she’s having a heart attack," says Dr. Shreya Kangovi , an internist with the University of Pennsylvania Medical System, and lead author of the new study. "She comes in, she gets stress tests, she gets EKGs, she gets cardiac catheterization she gets medication."

After six months of expensive hospitalizations, Kangovi says the patient was paired with a community health worker. It was at that point the patient opened up about a sexual assault.

"This had really traumatized her and it was leading to these feelings of panic and social anxiety," Kangovi says.

Ferreting out the source of the problem, says Kangovi, is really what the patient needed -- not going to the hospital every month. In fact, the patient returned just once after that. Kangovi says her randomly controlled trial found high-cost patients who were matched with health workers felt better, and were less likely to be readmitted multiple times.

Economically, this investment is smart, says Dr. Joshua Sharfstein, the Maryland Secretary of the Department of Health and Mental Hygiene.

"If getting admitted again and again, each admission is several thousand dollars, then it is pretty easy to save money with that kind of intervention," he says.

As more pressure is put on hospitals and doctors to save money, the idea of employing these workers is picking up steam.

"We’re proving out right now this is a great idea," says Bob Koche, a former healthcare advisor to President Obama. "We have a bunch of things done by people that are expensive, like doctors, that can be done by people who are lower cost like community health workers."

About the author

Dan Gorenstein is the senior reporter for Marketplace’s Health Desk. You can follow him on Twitter @dmgorenstein.
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Remember America no longer has "healthcare," we have a "for profit medical business."
One of the largest for-profit hospital chains (Health Management Associates) is being investigated for having implemented software that tracks ER doctors admission rates and posts it daily, chastising those who do not meet quotas.
Patients are being exposed to dangerously high doses of X-Rays by doctors prescribing unnecessary CAT scans.
Doctors who own or invest in labs prescribe 4 times as many tests as doctors who do not.
Drug companies like Johnson & Johnson and GlaxoSmithKline pay giant fines (~$6billion in recent years) for convincing doctors to prescribe drugs off-approval. The fines are a tiny fraction of the profits they make on drug sales. They also bribe other companies to prevent generics from being marketed after patents expire and pay doctors to write glowing articles about their drugs.
The list goes on and on and on.

I find this story appalling. It is a sad comment on the nature of the medical practice, where it seems that physicians have abdicated their responsibility, indeed their privilege, to take a thorough history and understand the patient as a human being and not just a set of symptoms.
If "Ferreting out the source of the the problem" was not the duty of the numerous physicians involved in her repeated hospitalizations, then what is it? Are these physicians just technicians evaluating laboratory data and doing procedures without actually talking to the patient? No wonder the cost of healthcare becomes astronomical.

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