Speaker:

Margaret Brown, DHA, MPH, BSN, RN, CCM

Description:

Jackson Health Network (JHN), in partnership with Henry Ford Jackson Hospital (HFJH), expanded the scope of Community Health Workers (CHWs) by embedding them in the Emergency Department and acute care settings. JHN, a clinically integrated network, had seen much success implementing social determinants of health (SDOH) screening in its primary care practices after working with the community to develop a closed-loop referral system: the Jackson Care Hub. JHN utilized CHWs to work in conjunction with their Case Managers and they were essential in bridging the gap between achieving positive medical outcomes and effectively addressing social needs. Unfortunately, there was a significant gap in screening for and assessing SDOH in acute care settings. The workflows and cultures of community-based organizations varied significantly from those in hospital. Recognizing this barrier and understanding the overwhelming impacts that unmet social needs have on the health of a population, JHN applied for and received a Visioning Award from Blue Cross Blue Shield of Michigan to test having a CHW embedded in both the acute care and Emergency Department settings. The goal of this program was to provide people with additional opportunities for engagement with a CHW who could initiate long-term navigation assistance while they were in a vulnerable state of health. The success of this initiative relied heavily on Case Management collaboration, and the program has been sustained since implementation (January 1, 2020). There were multiple learnings and challenges that took place during implementation, and some persist today. However, the information is useful when highlighting the importance of CHWs, and how to incorporate them into Case Management teams (inpatient and outpatient) and acute care settings. A deeper analysis of the direct impacts on utilization is forthcoming, however, as one of many population-based interventions to support value-based outcomes, the organization is experiencing a decrease in overall ED utilization. Lastly, process-based outcomes support that having a CHW in these settings expands the footprint for addressing unmet needs for people in the Jackson community.

Learning Outcomes:

• Demonstrate the value of community health workers (CHWs) via population based outcomes
• Examine how to incorporate CHWs into case management operations
• Enumerate how having a CHW in these settings expands the footprint for addressing unmet needs

Credit Information:

The Commission for Case Manager Certification (CCMC) is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

This program has been pre-approved by The Commission for Case Manager Certification to provide continuing education credit to CCM® board certified case managers. The course is approved for 1 CE contact hour(s). Activity code and Approval number will be awarded on your certificate of completion.

This program has been pre-approved by The Commission to provide continuing education credit to CDMS® board certified disability managers. The course is approved for 1 CE contact hour(s). Activity code and Approval number will be awarded on your certificate of completion.

To earn contact hours/CEs: In order to earn your contact hour(s)/CE, you will have to watch the presentation in its entirety and complete the survey. Once both the presentation and survey are marked as complete, you will receive your Certificate of Completion. If you are a CCM, your CEs will automatically record in your CCMC account.

Disclosures:

All planners and speakers have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

Commercial Support or Non-Commercial Sponsorship:
There is no commercial support for this activity. The planners and faculty have no relevant relationships to disclose.

Expiration date: 11/27/2026