MN COMMUNITY HEALTH WORKER AND

COMMUNITY PARAMEDIC OVERVIEW

Health Care Alliance Quarterly Meeting

February 6, 2015

Kay Herzfeld

Emerging Professions CoordinatorOffice of Rural Health & Primary Care

Minnesota Department of Health

Community Health Workers • American Public Health Association Definition:

A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competency of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.

CHW Job Titles

CHWs work under many different job titles, depending on where they live and work, including:• promotores de salud/promatora• community health representative• community advisor• , outreach worker• peer educator,• patient navigator

In January 2010, CHWs were officially recognized by the Department of Labor, Bureau of Labor Statistics, as Standard Occupational Classification 21-1094

CHW Education and Training

Minnesota is currently the only state in the United States that offers a CHW curriculum in higher education.

• Curriculum includes: • Core Competencies: 9 credits

• Role, Advocacy and Outreach – 2 • Organization and Resources – 1 • Teaching and Capacity Building – 2 • Legal and Ethical Responsibilities – 1 • Coordination and Documentation - 1 • Communication and Cultural Competency - 2

• Health Promotion Competencies: 3 credits • Practice Competencies – Internship: 2 credits

CHW Education and Training

Seven schools offer the certificate program: • Minneapolis Community and Technical College, Minneapolis• Normandale Community College • Northwest Technical College, Bemidji (hybrid: online/in-person) • Rochester Community and Technical College, Rochester (as needed) • St. Catherine University, St. Paul• South Central College, Mankato (online) • Summit Academy OIC, Minneapolis

• In order to enter the program, a CHW must have a high school diploma or completed a GED.

• To date, 614  students completed the certification curriculum.

CHW Employers

Of the 614 students who completed the CHW certificate program, 267 are known to be working as a CHW.

CHW Employers:

• Community-based Nonprofits • Clinics and Hospitals • Federally Qualified Health Centers • Public Health Departments • Dental Clinics • Community Mental Health Centers• Faith-based Networks

CHWs by County, 2015

2007 Minnesota Statute (MS 256B.0625, Subd. 49)

CHW Payment and Reimbursement

Supervision• MHCP requires general supervision of CHW by an MHCP

enrolled (ordering provider):• Physician• Advanced Practice Registered Nurse• Certified Public Health Nurse• Dentist• Mental Health Professional

MHCP Enrollment • MHCP requires CHW enrollment so they are

represented on a claim as the rendering provider.• As of Jan. 2015 only 53 CHWs enrolled.

CHW Payment and Reimbursement

Covered Services• Educating patients on how to effectively self-manage their physical,

oral and mental health.• CHW services are provided face-to-face with recipients (either

individually or in a group) in their home, outpatient clinic, or other community setting.

Non-covered services:• Enrollment assistance• Case management• Advocacy

CHW Payment and Reimbursement

Bill in 30 minute units• Limited to 4 units per 24 hours• No more than 8 units per calendar month• No more than 8 recipients can present for the service at a given

time.

Billing Codes and Rates • 98960 - self-management education and training face to face; 1

patient . Rate is $19.44 per unit. • 98961- self-management education and training face to face; 2-4

patients. Rate is $9.09 per unit. • 98962 - self-management education and training face to face; 5 8

patients . Rate is $6.56 per unit.

Rates as of Dec. 2014, and are subject to change.

Community Paramedics

In 2007, as a means of addressing the sustainability of rural ambulance services and primary care workforce shortages, Minnesota funded a pilot program to educate skilled paramedics to increase their role in providing primary care to the uninsured, underinsured and medically underserved communities.

A “Flex Grant” was provided by the Minnesota Department of Health, Office of Rural Health, to train 10 paramedics to this role.

The Community Paramedic model was based on best practices of similar initiatives around the world, including the Alaska Community Health Aide, the Nova Scotia Community Paramedic model and the Australia Rural and Remote Paramedic Program.

Pilot test

2011

Education and Training

• CP concept grew from the traditional career ladder of Emergency Medical Technicians (EMTs)

. • Certified First Responder• Emergency Medical Technician – Basic (EMT-B) • Emergency Medical Technician – Intermediate

(EMT-I). • Eventually, EMTs can obtain a certification to

become an Emergency Technician – Paramedic (EMT-P).

• The Community Paramedic certification offers career Paramedics another level of training and a new way to contribute their skills.

• Program consists of 114 didactic hours and 196 clinical hours which leads to the attainment of 14 credits toward a degree.

Training Schools

• Hennepin Technical College

• First CP certification program in U.S. • 2012 first graduating class• Trains students all over the country• Virtual / ITV – for non-clinical hours

• Inver Hills Community College

• Program started 2014

• 110 Total Minnesota CPs trained to date.

Certification

• EMS Regulatory Board

• Must be currently certified as a paramedic and have two years of full-time service as a paramedic or it’s part-time equivalent.

• Successfully complete a community paramedic education program through an accredited college or university.

• Practice under the supervision of an ambulance services medical director

• Recertification every 2 years

• 88 Certified CPs to date.

Supervision • Works under the direction of an ambulance services Medical

Director in coordination with patient’s primary care physician.

Scope of Practice / Services Provided• Health assessments• Chronic disease monitoring and education• Medication compliance• Immunizations and vaccinations• Laboratory specimen collection• Hospital discharge follow-up care• Minor medical procedures approved by the Ambulance Medical

Director

CP Payment and Reimbursement

• 2012 MN first state in U.S. to provide MA reimbursement for CPs.

• Billed under an enrolled MHCP Ambulance Services Medical Director

• Services part of a care plan ordered by a primary care provider (physician, advanced practice RN, physicians assistant)

• “Face to face” time with patient covered only (approx. $60.00 per/hour)

• Not covered: • Travel Time• Mileage• Facility Fee• Services related to hospital acquired conditions or treatments

North Memorial

Hennepin Cty Med Ctr

Allina

HealthEast

Shakopee Mdewakaton Tribe

Tri County Hospital/EMS

Lakewood Health System

Scott County

Essentia Ada

Ringdahl

Park Rapids

North-Brainerd

Operating Planned

CPs included in Medicaid ACOs

2014: It’s official – there are savings!