A Workforce for the New Era of Equitable Health Care

00;00;00;26 - 00;00;23;23
Tom Haederle
It's been forecast for years. The retirement of the baby boomers is exacerbating our already urgent shortage of health care workers and creating new challenges that must be faced now. It's estimated we'll need at least 3.5 million health care workers in the next five years to meet demand. Where will they come from, especially when high rates of burnout are causing so many health care professionals to leave?

00;00;23;25 - 00;01;02;06
Tom Haederle
Experts say we may be overlooking an important source of new talent. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle, with AHA communications. Community health workers aren't trained nurses or physicians, but they can provide critically needed skills in the health care space, including social support, care coordination, navigation and advocacy...at a fraction of the cost of clinical labor.

00;01;02;08 - 00;01;28;09
Tom Haederle
In fact, one expert calls community health workers the new American health care workforce. In this podcast, Joy Lewis, senior vice president of Health Equity Strategies and the executive director of AHA Institute for Diversity and Health Equity, speaks with three guests who believe that expanding the number of trained community health workers and integrating them more fully into hospital and health system operations could go a long way towards meeting our future health care needs.

00;01;28;11 - 00;01;44;29
Tom Haederle
Joining Joy today are Dr. Shreya Kangovi, associate Professor of Medicine at Penn Med; Tawandaa Austin, lead community health worker and product specialist at Penn Med; and Dr. Briar Ertz-Berger, Northwest Medical director for Social Health and Quality Management.

00;01;45;01 - 00;02;09;04
Joy Lewis
Thanks, Tom, and welcome, Shreya, Tawandaa and Briar. Thank you very much for taking time today to speak with me about the value of integrating community health workers into the operations of hospitals and health systems. We're going to kick off our conversation with you, Briar. And I want to ask you about some of the macro changes that you see happening in the health care field right now.

00;02;09;04 - 00;02;13;28
Joy Lewis
And what pressures are these changes putting on hospitals and health systems?

00;02;14;01 - 00;02;45;11
Dr. Briar Ertz-Berger
Yeah, I appreciate that. And thank you very much for the invitation to the conversation today. Pertinent to this conversation. I would call out a few specific things. You know, we're seeing big changes in our patient population, the populations that we're serving. We're seeing tremendous pressures put on our clinical workforce and we're seeing some exciting, innovative things happening in the regulatory and accreditation space. In looking at the patient population,

00;02;45;11 - 00;03;11;14
Dr. Briar Ertz-Berger
I think it's important to call out. I mean, there are some trends we've been talking about for years. I mean, the baby boomers are retiring, so we have a growing population of patients and people we're serving over 65. And with that comes a greater burden of disease and chronic illness. I think it's one thing to call out, you know, over 25% of people over the age of 85 have dementia or some sort of cognitive decline.

00;03;11;16 - 00;03;43;22
Dr. Briar Ertz-Berger
And then this older population, this larger older population, and our population in general, has been impacted by the pandemic. You know, there was a time when the pandemic first hit that we were sheltering in place. People were afraid to come in and access health care. You know, clinics were closed. Providers were ill. And so, you know, for months and even for over a year, we saw big delays in care. Patients and people were more socially isolating and not moving their bodies very much.

00;03;43;22 - 00;04;10;12
Dr. Briar Ertz-Berger
So we saw, you know, older folks, especially with loss of physical function and the loss of social interactions led to worsening cognitive decline. And then I think we have to call it the COVID effect. We're learning more and more about long COVID. You know, we've seen higher rates of strokes and heart attacks post-COVID. We've seen impacts again on patients cognition, vascular effects.

00;04;10;14 - 00;04;34;18
Dr. Briar Ertz-Berger
We're just starting to learn this and unpackage this more. And so, you know, you kind of take all this together population who has a larger number of people over 65, greater burden of chronic disease, big impacts from the pandemic on the population in general. We're just seeing people presenting to the hospitals who are sicker than they were pre-pandemic.

00;04;34;21 - 00;04;57;07
Dr. Briar Ertz-Berger
We don't expect that trend to change. And then I would also add a layer of complexity on there. You know, I think that's very important for us to talk about. You know, we are looking at a population with fewer social resources. And what I mean there I'm talking about patients having know, lack of reliable financial resources, food, housing, transportation.

00;04;57;09 - 00;05;23;23
Dr. Briar Ertz-Berger
And there's various reasons for that. You know, we've seen a lot of loss of jobs, business closures, inflation that we're all struggling with. And then you can compound that with the other big macro change that I was mentioning, which is the tremendous pressures we're seeing on the health system workforce. You know, there's been multiple causes of health care, workforce shortage.

00;05;23;23 - 00;05;51;17
Dr. Briar Ertz-Berger
We already knew this was coming. But as we're talking about, you know, the baby boomer generation retiring, that means a lot of physician nurses, clinical staff are retiring. There's also a big increase in health care worker burnout and, of course, exodus of health care workers from during the pandemic. The shortage of clinical staff is not just physicians, but it's physicians, nurses, EMS techs.

00;05;51;17 - 00;06;04;07
Dr. Briar Ertz-Berger
And it affects every sector of the health care system. Right? Primary care, specialty care, the hospital, the post-acute space. So we're looking at this really severe mismatch of resources.

00;06;04;09 - 00;06;40;00
Joy Lewis
Well, you've certainly laid out for us a very complex landscape following the pandemic. And what we're seeing even and even prior to the pandemic, where you talked about just the an older, sicker patient population, an older population, meaning there's probably greater reliance on on government payers, Medicare in this case. And so looking at some of the nonmedical needs, those societal factors that we know impact one's overall health status and well-being.

00;06;40;03 - 00;07;09;12
Joy Lewis
I don't think we even touched on on the renewed call for social justice and racial justice and how that shows up in the health care space around really doubling down our efforts to eliminate health disparities. And all of this with a backdrop of, I know at least for hospitals, we issued our Cost of Caring report earlier this year and the financial picture is pretty gloomy.

00;07;09;14 - 00;07;41;04
Joy Lewis
I think we're we projected that over 60% of our hospitals will end this year in the red. So lots of very complex issues to solve for. So, I want to pivot to Shreya and ask her to then help us to kind of better understand how do community health workers fit into this larger macro environment that Briar just outlined for our listeners?

00;07;41;06 - 00;08;02;03
Dr. Shreya Kangovi
Yeah, I think she said it perfectly. You know, we need to keep an aging poorer America healthy at lower cost and with fewer clinicians. How are we going to do that? We have to push health care out of the glass walls of the ICU into the community. That is where so much of health and well-being are shaped, especially for older adults, or working class Americans.

00;08;02;05 - 00;08;24;20
Dr. Shreya Kangovi
And, you know, the shift to communities is being accelerated by the move from fee for service to value based models that capitate costs and require quality. And we are seeing that the biggest companies not only in our sector but in the entire U.S. economy, are making huge bets on this push of health care into the community. A CVS, Walmart, Amazon.

00;08;24;22 - 00;08;51;26
Dr. Shreya Kangovi
But I'd argue they aren't going to get there because they are constrained by workforce. Most of the American health workforce are clinicians like me. We mean well. But I would argue that we are overrepresented as a sector of the workforce because our main lever is medical care and that only accounts for 15% of health outcomes. And we're less well positioned to address the social, behavioral and economic factors that shape the health of most Americans.

00;08;51;26 - 00;09;18;10
Dr. Shreya Kangovi
And that is where community health workers come in. They are the new American health workforce. These are trustworthy people who come from within the communities they serve. They can provide social support, care, coordination, navigation and advocacy at a fraction of the clinical labor cost. When we want to talk about, you know, there are nurse or physician shortages. That may be true, but there are only 50,000 community health workers in the entire country.

00;09;18;12 - 00;09;35;21
Dr. Shreya Kangovi
So that's a shortage we haven't even begun to wrap our minds around. And I think that's the real focus here, because when we think about who is the workforce that is going to produce health, not necessarily just medical care, but health, we have a severe community health workforce shortage.

00;09;35;23 - 00;10;08;11
Joy Lewis
So I'm hearing you make the case for us to actually expand the definition of the workforce of the health care workforce, to include community health workers and and other similar community based resources. So I want to at this point introduce Tawandaa, really invite her into the conversation because Tawandaa is a community health worker. So can you tell us a little bit more about who you are Tawandaa as a person, and what do you do as a community health worker?

00;10;08;11 - 00;10;29;15
Joy Lewis
I know at times there's some confusion around role differentiation between case managers and some nurses who may serve as case managers or a program manager, a social worker. So can you clearly articulate for our audience today who you are and what you do as a community health worker?

00;10;29;18 - 00;11;00;09
Tawandaa Austin
My name is Tawandaa and I am from Philadelphia, Pennsylvania. I was raised by primarily by my grandmothers. My grandmother, she had diabetes, she had blindness, and I learned that the reason why we would cross the street, we would have to wait several times across the street was because she had some trauma around crossing the street due to being hit by a truck once when she was younger.

00;11;00;11 - 00;11;23;27
Tawandaa Austin
I have the lived experience through, you know, growing up in an environment that I grew up in, which is of course, Philadelphia was Philadelphia. So it was in a Germantown section. So I kind of know the areas. And when when my patients tell me where they're from, I can easily identify that region. So that's what makes it more alive to me.

00;11;23;29 - 00;12;02;02
Tawandaa Austin
But the most unique part about my job is that when I meet patients, I'm meeting them where they are. I primarily work in primary care with those patients who are working on long term chronic health goals with their provider. And my job is to assist them to get to the finish line. They may identify by certain stressors that they have or like violence in a neighborhood in food deserts, issues with paying for their medications and all of these different attributes that makes it harder for them to reach their long term chronic health goals with their provider.

00;12;02;05 - 00;12;24;04
Tawandaa Austin
So one of the things I just do is just to talk to them, get to know them a little bit better, see what's important to them, their goals, their fears, and really just focus on them as a person to help their goals become more manageable. So I might provide resources and just emotional support depending on the patient and where they are in their journey.

00;12;24;06 - 00;12;49;15
Joy Lewis
Wow. Sounds like really impactful work. Really the definition of what we, many of us refer to as patient centered care, where you are meeting folks, where they are and aligning with their health goals, and how might you then help them to achieve and inch their way closer to pursuing their health goals. How long have you been doing this work, Towandaa?

00;12;49;17 - 00;13;07;25
Tawandaa Austin
I was born a community health worker, I definitely have to say that. Actually doing the work and getting paid for? I would say this is my seventh year at Penn Center for Community Health Workers. Okay. Okay. I definitely I have a story to if we have time, I have to make those to make my work come alive.

00;13;07;27 - 00;13;12;02
Joy Lewis
I'd love to hear more about your story. So I'm going to give you the floor.

00;13;12;04 - 00;13;34;25
Tawandaa Austin
So I had a patient by the name of Mrs. T, and Mrs. T was assigned to me for six months to work on a decrease in her agency. What I will call Mrs. T at least once a week. And I would like try to type that and say like Mo and I would get nothing from Mrs. T. And I think it's because of all of the mistrust.

00;13;34;28 - 00;13;59;11
Tawandaa Austin
So one day she finally answered, and I learned that she wanted to have home care services. And I kind of use that to try to build the connection between her and primary care provider, because there was a mistrust between them, too, because the provider was a resident doctor and she was new. So the patient felt like she didn't know her or wasn't here and the request that she was trying to get.

00;13;59;13 - 00;14;34;21
Tawandaa Austin
So one of the things that I did was demonstrated to Mrs. T that I have her back by talking to the doctor and in explaining or advocating on her behalf of why the services were necessary. So when Mrs. T saw that I was able to do that for her, she then allowed me to come to her home. And then when I came to her home, she shared more with her story of, you know, being sexually abused as a young child and then conceiving a child and then her child having a child at the age of 14.

00;14;34;22 - 00;15;05;16
Tawandaa Austin
It was like a cycle that kept on going. And she was embarrassed because she had bedbugs and she she didn't want me to see her environment. But I when I came in, I acted like it was my home. She sat on the floor. I sat on the floor with her and we and we talked. And I got a chance to really get to understand, like, what's causing her or preventing her from reaching her long term goal and how can I better assist her with resources around getting the services that she needed.

00;15;05;19 - 00;15;24;09
Tawandaa Austin
So while I worked on it, I thought to myself, what would make me feel good in this time, in this time of need? Or, you know, when I don't, when my light is dim, like, how can I brighten up Mrs. T's light? So I went out and I got zoo tickets for her one year old granddaughter. They've never been to the zoo, yet they live so close.

00;15;24;09 - 00;15;45;23
Tawandaa Austin
But it's really costly. They didn't have any the money to go there. So I got four zoo tickets and I me kind of made the family like their own custom bag, depending on like what I heard them say when I was interacting with them in the living room. And I got Mrs. T a hair weave and we had a we had a make over and that was she loved it.

00;15;45;23 - 00;16;02;25
Tawandaa Austin
And so I was able to provide her with just the hope, just to make her feel better and let her know that she is appreciated despite how she was feeling and the fact that she didn't feel like she was being heard. So it actually helped the rapport and it really strengthened the rapport with her, her provider as well.

00;16;02;26 - 00;16;07;08
Tawandaa Austin
So she felt comfortable enough to go to her provider when she needed things.

00;16;07;10 - 00;16;16;25
Joy Lewis
I mean, that level of engagement that you're describing simply just cannot happen in a clinical setting, right.

00;16;16;25 - 00;16;17;27
Tawandaa Austin
You know, you're.

00;16;17;27 - 00;16;39;12
Joy Lewis
Sitting on the floor right there with her, right? Yeah. Yep. Your ability to to put yourself in her shoes, I mean, that's just that's remarkable. And then the carry through, the carry over, and how that then positively impacted the relationship with the provider. Right.

00;16;39;15 - 00;16;40;07
Tawandaa Austin
Yes.

00;16;40;09 - 00;17;08;12
Joy Lewis
That's a really compelling story. So I guess I would want to turn to Shreya, because you're a part of the Penn program that she's spent her blood, sweat and tears building out the impact model. And the goal really is to try to spread and scale the kind of magic that you just described for us Tawandaa. And so I'm going to ask you to tell us a little bit more about the work that she's been leading and the evidence behind it.

00;17;08;14 - 00;17;39;17
Dr. Shreya Kangovi
Yeah, thank you. Well, you know, stories like Tawandaa are what gets me out of bed in the morning. And the goal of impact is to make sure that those sorts of stories remain magical, but they're not accidental. So we've tried to answer the question, how do you do magic with consistency? And it turns out that if you want to generate, you know, an enterprise scale community health worker program that is effective and sustainable, you have to get a few things right.

00;17;39;19 - 00;18;05;25
Dr. Shreya Kangovi
Number one, you have to hire the right people. As Tawanda said earlier, she was born a community health worker. This is a calling. It's not just a job that you can solve for by posting a job on Indeed or going through a two week training and certification program. We in the impact model help organizations by recruiting and assessing natural helpers from within local communities.

00;18;06;01 - 00;18;24;27
Dr. Shreya Kangovi
And we use behavioral interviews, for example, to gauge traits like empathy and non-judgment and reliability and listening skills so that at the end of the day, you have people who are just tailor made for this job and who are set up for success. So the first thing is kind of hiring is a core part of the impact model.

00;18;24;27 - 00;18;57;17
Dr. Shreya Kangovi
The second piece is training. And our insight there is that you can't just train community health workers. You have to train both community health workers and supervisors and program leaders. And so we offer really experiential training at all of those levels, as well as ongoing professional development. Being a community health worker is a profession. Sometimes you hear about folks saying, oh, you know, community health workers, you know, maybe they can graduate on to becoming social workers or becoming nurses know being a CHW is a profession.

00;18;57;17 - 00;19;24;27
Dr. Shreya Kangovi
So we support CHWs all across the country in being able to progress in their field and advance and gain additional skills, whether it's direct patient care or advocacy or community mobilization, etc.. So recruitment, hiring, training. Then there's the actual workflows. You know, Towandaa mentioned that she met Mrs. T where she was. She got to know who she was as a person.

00;19;24;27 - 00;19;51;24
Dr. Shreya Kangovi
She asked her, you know, Mrs. T, what do you want and what do you think will improve your health? And she provide tailored, person centered support to that. And that doesn't come accidentally. There are workflows that we've developed and tested with at this point over 70,000 patients in multiple clinical trials and we've really refined these socio behavioral practices through which community health workers can provide effective tailored support.

00;19;51;27 - 00;20;18;17
Dr. Shreya Kangovi
And then the final layer is infrastructure and supervision for CHWs, you know, and that takes into account performance assessments, support coaching, compensation and those are additional managed services that are part of the impact model. So, you know, sometimes a community health worker program sounds so intuitive and there's a risk of, oh, this is so simple. You know, any hospital can create their own community health worker program.

00;20;18;17 - 00;20;40;22
Dr. Shreya Kangovi
Right? But CHWs have been around for 300 years and many of those programs have really struggled in that time. And we really have tried initially at Penn and now with our spinout called Impact Care, to just make this process streamlined, effective and sustainable for organizations who are really trying to grow this workforce.

00;20;40;24 - 00;21;07;19
Joy Lewis
So you're describing a level of intentionality that is required if one is to design and stand up a successful CHW program. You know, your comment around hiring the right people cause me to think of the author Jim Collins in his good his book Good to Great, where he talks about how do you take an organization from being good to great and and he said, you know, too often we talk about our biggest asset being our people.

00;21;07;22 - 00;21;27;27
Joy Lewis
And he said, but it's got to be the right people. You have to get the right people in place, because then you can actually pivot and, you know, you can get folks to to do the actual work you need to do if they're already motivated around the mission and the vision and are in alignment with the broader goals.

00;21;27;27 - 00;21;30;03
Joy Lewis
But you have to get the right people on the bus.

00;21;30;10 - 00;21;51;12
Dr. Shreya Kangovi
Yeah, absolutely. And, you know, there's there's a real risk, I think, to your audience, because in the field, you know, people tend to be reductionist and think about community health workers as just a training function and then think about their workflows as, okay, let's screen for unmet social needs and refer to resources. Both of those approaches are highly reductionist.

00;21;51;12 - 00;22;22;21
Dr. Shreya Kangovi
You asked about our outcomes. Impact has the strongest outcomes for any CHW program in the country, including a $2 and 47% return on investment annually and a 70% patient engagement reduction of total hospital days of 66% compared with matched controls, improved A1 c BMI, systolic blood pressure, improved quality through caps and H-caps. You you can't get those outcomes without the inputs that I described, right?

00;22;22;23 - 00;22;25;24
Dr. Shreya Kangovi
So that's really kind of the key point.

00;22;25;27 - 00;22;50;06
Joy Lewis
So let's talk about that. Brier, You've spent some time as a health system leader, really building a CHW workforce. What what is that experience been like and what are some learnings and pitfalls to avoid some lessons you might share for other health system leaders who might be thinking about standing up one of these programs?

00;22;50;08 - 00;23;21;14
Dr. Briar Ertz-Berger
Thank you for asking. I've had this conversation with and without Shreya training multiple times. The journey has been transformative for me personally and also, I believe for our the health system and the teams that these CHWs are embedded working with and actually got connected to Dr. Kangovi through mutual contact. I struggled, I initially struggled. They came and gave us the pitch and I really struggled with the concept of how CHWs

00;23;21;15 - 00;23;48;19
Dr. Briar Ertz-Berger
were going to be supporting patients with complex physical and mental health diagnoses. So it was a very humbling experience to come in contact with, you know, Shreya's program and to really start thinking about this industry. I had said like kind of blasting over open the glass walls of how I was thinking about health and how we've been traditionally thinking about health in our country as being generated by a physician and nurse working in partnership with a patient.

00;23;48;24 - 00;24;09;25
Dr. Briar Ertz-Berger
You know, that's not entirely true. You know, so strong leadership is is various is essential. You need to get your leadership on board. And they have to deeply understand this model because it's it's going to require change management. And as with all change management, you're in it for the long haul. There are going to be people who are skeptical.

00;24;09;25 - 00;24;20;10
Dr. Briar Ertz-Berger
As I was just saying, because this is introducing a non-clinical role into a clinical setting and folks are going to have to understand how that works and you're going to need clinical champions.

00;24;20;13 - 00;24;22;25
Joy Lewis
It's a paradigm shift almost, right?

00;24;22;27 - 00;24;42;23
Dr. Briar Ertz-Berger
Absolutely. And it's really essential that the supervisors and the folks that are going to help run this program deeply understand the work and they can create a safe working environment for the team. Because, you know, as Tawandaa talked about, you just listening to the story that she had shared, there's a lot of very intimate and personal details and information that are coming from that team.

00;24;42;25 - 00;25;01;18
Dr. Briar Ertz-Berger
You should be working also with a patient population who has dealt with poverty and racial discrimination. And so you've got to create the safe working environment for the people who are doing the work because there's a lot of secondary trauma that they're going to experience. And there's got to be, you know, tremendous amount of support that's provided.

00;25;01;20 - 00;25;07;18
Joy Lewis
But I'm hearing you say. Briar, that there's room for for multiple disciplines at the table.

00;25;07;24 - 00;25;08;17
Dr. Briar Ertz-Berger
Absolutely.

00;25;08;24 - 00;25;16;23
Joy Lewis
You know, you can have your social worker still on the team, as you should. But that doesn't you know, it's not a zero sum game right?

00;25;16;23 - 00;25;32;11
Dr. Briar Ertz-Berger
And this is not a replacement for you know, our in care managers or social workers. Absolutely not. They this is an addition to the team that has been sorely needed for a very long time. You know, it complements these clinical roles and allows them to work at top of scope.

00;25;32;13 - 00;26;20;11
Joy Lewis
You know, you remind me of when I was at Kaiser Permanente and a leader in preventive medicine, Dr. David Sobel. I don't know if you know that name. He coined the phrase "patients are the true primary care providers." And I don't know that that landed very well with his colleagues. But, you know, as I'm listening to Tawandaa's reflection on her time in Mrs. T's home and and the program you stood up, and just it just really makes sense that we ought to rethink who's at the nucleus, who's at the center of all of our work, and how do we then create the care plan around what the patient is identifying as as their health goals.

00;26;20;13 - 00;26;59;09
Joy Lewis
So super helpful. Tawandaa, do you want to weigh in here and talk a little bit more about how your role as the CHW adds a different flavor, a different element, if you will, to the work that we're all after, which is, you know, to make patients lives better. And how in particular does your lens that you apply to the work that you do, how is that different from other approaches like, you know, screening for social needs or referring patients to community based organizations?

00;26;59;11 - 00;27;08;04
Joy Lewis
If you can speak a little bit around how CHWs differ compared to other population health approaches, that would be helpful.

00;27;08;06 - 00;27;33;13
Tawandaa Austin
I would say they're scaled up. Use definitely differ because often physicians are confined to the room with their patients. I get to go to different places in a community with patients. I get to just really dive deeper, be in their homes. That's really intimate. I really get to look at the family portraits and get to know a lot more to you that a physician would learn with the short period of time.

00;27;33;13 - 00;27;54;16
Tawandaa Austin
I really don't have the time frame of working with patients in the day. I can spend as much time is as it's appropriate rather, and I get to use my creativity. I get to be myself. I can identify with the patients. I've been through more than half of the things that they've been through. I am a patient, so I understand them.

00;27;54;16 - 00;28;15;17
Tawandaa Austin
I can use empathy instead of sympathy to really just be in moments with them during the most trying times that they that you can ever imagine. I just get to be there and maybe just like, take a pause and just really just be in a moment with them to try to, you know, ease their mind or try to come up with other ways to make them feel appreciated.

00;28;15;17 - 00;28;19;25
Tawandaa Austin
And really give them there that sun healthy shine again.

00;28;19;27 - 00;28;30;07
Joy Lewis
There's such an authenticity when I listen to you speak I mean it's it's amazing I see how that then translates into trust building, right?

00;28;30;09 - 00;28;31;09
Tawandaa Austin
Absolutely.

00;28;31;12 - 00;28;33;09
Joy Lewis
Sure. You wanted to say something?

00;28;33;12 - 00;28;55;27
Dr. Shreya Kangovi
Yeah. I wanted to add, I think it's really important to contrast and evidence based community health worker model with social needs, screening and referral. It's about power. When someone, you know, either a community health worker or clinician, you know, sits at a computer and says, you know, are you being abused at home? Do you have enough food to eat?

00;28;56;02 - 00;29;26;27
Dr. Shreya Kangovi
Click, click. Here are some food pantries. There is no power changing hands. It is still, you know, the sort of privileged clinical system that is pathologizing the people who may have experienced health inequity or poor health outcomes and just, you know, the approach that Tawandaa is taking is the opposite. She is meeting them literally where they are, and she is asking them what they need and helping them do that.

00;29;26;27 - 00;29;52;10
Dr. Shreya Kangovi
It's about power. And I think perhaps not coincidentally, that's why it works. You know, that the as much as we've seen social need screenings and closed loop referrals just propagate across our health systems. And they they certainly do have a role. But they have not been proven to improve downstream health care costs and they have pretty low rates of patient engagement.

00;29;52;10 - 00;30;11;15
Dr. Shreya Kangovi
You know, patients know where the food pantry is. They passed it on the way to the clinic. Did you? So the real evidence is behind these person centered approaches where people get to say what they need, and a community health worker who shares life experience with them supports them on that journey.

00;30;11;18 - 00;30;49;21
Joy Lewis
Well, if health is our cause, I almost get goosebumps when I read the AHA's vision statement, which we revised just a couple of years ago, the vision is of a "just society of healthy communities, where all individuals reach their highest potential for health." And at the end of the day, if we keep that as our North Star, then it's really hard to create plans outside of the wishes and the desires of the patient in front of us.

00;30;49;23 - 00;31;29;01
Joy Lewis
And so I really want to thank all of you so much for your time spent today, and in particular for elevating for our audience how community health workers are vital are critical. They're a key component to the equation when it comes to advancing health and inching our way again closer to equitable care. And so at the American Hospital Association, we actually have developed a number of resources to advance health equity and support our members in the work that they do day in and day out on behalf of the patients and families and communities that they serve.

00;31;29;01 - 00;31;53;19
Joy Lewis
And so I would invite our listeners to look more into our health equity roadmap. That's a national initiative that we launched last year to drive improvement in health care outcomes, to address the disparities that we know exist and have long existed, to really begin to tackle our work environments, to make sure that they're more diverse and representative and inclusive.

00;31;53;22 - 00;32;33;03
Joy Lewis
There's also our hospital community collaborative, and through that work we provide really proven to Shreya's point earlier, the evidence that's needed the insights, the resources to create sustainable collaborations between hospitals and community organizations with the goal of accelerating health equity and advancing health. And I think we we know on this call that too often, as you just talked about, the power dynamics, that the community voice is left out of the conversations and out of the solutions as we're busy developing them.

00;32;33;03 - 00;33;08;16
Joy Lewis
So one, to call out those two pieces of work and also our Community Investment for Health portfolio, where we're looking at those upstream factors that influence one's health. So again, thanks for listening and for more information, I would invite everyone to visit our web site: IFDHE.aha.org. Thanks everyone.