Community Health Workers Keep Patients Connected During COVID-19 Pandemic
When COVID-19 blazed through New York City last spring, the health disparities that simmer beneath the surface during non-pandemic times were soon thrust into the spotlight.
This was no surprise to Adriana Matiz, MD, professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons who helped establish a program 15 years ago aimed at improving patient care through support from local community members serving as community health workers.
In a recent article in New England Journal of Medicine, Matiz and Patricia Peretz, MPH, who leads the Center for Community Health Navigation at NewYork-Presbyterian, explains how the program was poised to step in and quickly address the health care and practical needs of families who suddenly found themselves in lockdown.
We spoke with Matiz, who is also medical director of the Center for Community Health Navigation at NewYork-Presbyterian and a pediatrician in the NewYork-Presbyterian Ambulatory Care Network, to learn about what community health workers do and how the United States should consider empowering more of them to help during the pandemic and beyond.
What is a community health worker?
Community health workers are peers of our patients. At the NewYork-Presbyterian/Columbia University Irving Medical Center campus, our community health workers are Latino and Caribbean immigrants and live in the same neighborhoods in northern Manhattan and the Bronx as our patients. They are not licensed professionals. They do not have health care degrees and they aren’t required to have a college degree or even a high school diploma. They work out of local community agencies that are embedded in our area, like the Community League of the Heights on 159th Street and the Dominican Women’s Development Center in Washington Heights.
Why are community health workers important?
The value of these workers is in their community experience and in their personality, their temperament, their approach to working with others. They are proven community connectors who may have been leaders in their church or parents who were active in their local school. These are people who motivate others to improve their health and effectively connect them to local resources. They have positive energy; they build trust. These key team members are extenders beyond the faculty or resident practice. If we’re going to narrow disparities in health care, these team members are critical.
How did the community health worker program begin at NYP/CUIMC?
When I first arrived at NewYork-Presbyterian/Columbia, I was working as a primary care pediatrician in one of our ambulatory care sites. In my work at the clinic, I was seeing a lot of pediatric asthma. I was able to help families with their medical concerns, but I was challenged in my ability to help them with housing issues and other competing social barriers that led to poorly managed asthma—and more emergency room visits and hospitalizations—for their children. For instance, the mother might be facing unemployment, depression, or fear about her immigration status, all factors that could lead to poor health outcomes for her child and were beyond what I could provide in the clinic.
At around that time, we had an opportunity from the Merck Childhood Asthma Network to put in a proposal for a program to help us improve pediatric asthma management. That’s when we started to think about collaborating with people from local community organizations to connect these families with local resources around documentation status, food stamp benefits, and other non-medical concerns. So that’s where the inspiration for our community health worker model came from. NewYork-Presbyterian/Columbia developed the program in collaboration with community-based organizations in 2005.
Over the years, we've been able to expand our program to reach different patient populations based on grant or philanthropic opportunities presented to NewYork-Presbyterian. We developed community-based programs for adults with type 2 diabetes, children with special needs, adults with HIV, and individuals with behavioral conditions. The Center for Community Health Navigation now operates at five NewYork-Presbyterian campuses.
How are our community health workers providing support during this pandemic?
We very quickly developed a wellness outreach protocol, which involved having our community health workers call their current and previous clients, going back two years, on a weekly or bimonthly basis. We wanted to see how families were doing now that they were home and find out what they needed—not just how to connect to the medical system, but also what they needed in terms of educational support for their children, access to food stamp benefits, unemployment benefits, housing necessities, even basic things such as diapers.
Many of our families were facing extreme challenges, because their income only allows them to live day to day. If they were restaurant workers, they suddenly found themselves unemployed. These families needed food stamps and connection to food pantries with a level of urgency that we've never experienced before in northern Manhattan and the Bronx.
The pandemic also had a dramatic impact on the way we were delivering medical care. We went from in-person visits one day to no visits at most of our ambulatory care network clinics for a little while, until we were able to safely open clinics and reach out and check that our families had video systems so we could offer them telemedicine services. That shift meant getting many of our vulnerable patients on the electronic patient portal. And who best to do that but a community health worker?
Our community health workers made sure that these families had an email account, helped them download the application, and switched it to the language that they felt more comfortable with. They explained how to use the portal to email their practice, look at their labs, and schedule a visit. Without our community health workers, these families would not have had the access to care that they were able to obtain.
Our community health workers also provided COVID-specific information to our families. They educated families about when to call their physician and where to find testing sites.
Through this one phone call from a trusted source, we were able to make sure that these people were receiving accurate information about COVID-19 even while they were cut off from everything else.
By early summer, we started offering video visits, which gave us a whole new way to connect with our families.
Since March, our community health workers completed over 9,700 wellness checks among our adult and pediatric patients. They provided over 1,500 social service referrals, in collaboration with our community-based organizations. They also helped enroll over 4,300 patients into the electronic portal system, allowing them to virtually schedule and attend health care visits.
How were you able to help children access virtual classrooms?
Back in late March and early April, our pediatric program focused on finding out what devices children have at home and then connecting families to parent coordinators in the schools to help families that needed devices. We also connected these families to the utility companies that were offering some special rates or special programs for those who could not afford WiFi or pay their phone bill. The community health workers would call the utilities with their clients to help them explore those options. We were successful in connecting a large number of families with those important resources.
Do you expect the role of community health workers to expand as a result of the pandemic?
I’m optimistic about seeing an expanded role for community health workers because they have demonstrated they were able to play a key role during the pandemic, though we’ll see what happens with health care reform after the election.
Before the pandemic hit, New York State’s Medicaid system had begun to implement the use of value-based payment models. Community health workers are an important part of value-based programs because it’s been shown that they can help decrease unnecessary health care utilization that’s been so costly for us.
We’ve integrated community health workers into both inpatient and outpatient environments. Pre-COVID-19, they would round in-person at NewYork-Presbyterian Morgan Stanley Children’s Hospital and meet families with children who had been admitted with an asthma attack. We have embedded them into our interdisciplinary teams as equal members of the team, alongside the social worker, the psychiatrist, the pediatrician, the care managers. That has been transformative, because it brings the patient’s voice directly into our patient management team meetings, which is really powerful and has shaped us as a workforce.
We’ve seen there is a tremendous amount of benefit to including them in our extended health care teams. And part of that is due to the fact that they can do things that health care workers and the health care administration can’t do as effectively.
I think we have learned that if we bring community health workers to the table more formally, and in a manner that’s appropriately funded, we can really impact outcomes and reduce disparities in the community.
The article, titled "Community Health Workers and COVID-19 — Addressing Social Determinants of Health in Times of Crisis and Beyond," was published Sept. 23, 2020, in the New England Journal of Medicine.
The other authors are Patricia Peretz (NewYork-Presbyterian) and Nadia Islam (NYU Grossman School of Medicine).