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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