How trust and trusted data can help reduce healthcare inequality
The numbers are alarming. In 2018, the World Health Organization, reported the United States had the sixth highest number of preterm births in the world.
In the United States today, 10 percent of children are born premature—three or more weeks before their due date. According to the 2019 March of Dimes Report Card, premature birth in the State of Ohio occurs at a rate of 10.3 percent. In Hamilton County, which includes Cincinnati, the percentage climbs almost one percentage point. And the statistics become more disturbing from there.
In 2019, Black women in Ohio were 49 percent more likely to experience a preterm birth than their Caucasian, Asian and Hispanic neighbors. In 2017, deaths among African American babies in Hamilton County were three times greater than non-African American babies. Many of these deaths occurred because women delayed prenatal care or experienced a preterm birth.
But these numbers could go down as our Certified Community Healthcare Workers (C-CHW) are combatting these and other healthcare challenges facing our county.
Empowering the local community for support
Our organization, Health Care Access Now (HCAN), was launched by community leaders in 2009 to improve the overall health status of our most vulnerable residents in Greater Cincinnati. Our Certified Community Health Workers are the boots on the ground, focused on social determinants of health and the barriers a client is facing. We pair our workers with those who are likely to have poor health outcomes due to inconsistent medical care, challenges accessing behavioral and specialty care, or lack support in successfully managing chronic diseases. More than 55 percent of HCAN’s clients are expectant mothers while other clients include the elderly.
Essential to the mission are three ingredients: trust, skills and data.
Lending a hand, earning trust
Trust is a critical element to HCAN and its Certified Community Health Workers’ success. Clients are often referred to HCAN by Medicaid health plans, physicians, United Way 211 or others who have benefited from the service. During the intake process, clients first provide personal data and medical history then share their experiences and challenges. “Sometimes it’s hard to break through to clients,” according to Giacoma Telich, a Certified Community Health Worker at HCAN. “But I’ve been through a lot on my own, and I open up about my experiences. It doesn’t matter where you start from; it matters where you finish.”
Clients trust that their C-CHW will judiciously use the information they shared to find and deliver the services they need. The real trust begins as they see the many ways their C-CHW shows up in their life.
Separate paths converge into one journey
Community Health Worker isn’t a college major. These dedicated individuals develop their skills through facing life’s obstacles and professional training. They live in the communities they serve. They are in touch with the needs of the community. They may have faced similar challenges. Their life experience, determination and compassion help them relate to their clients on a personal level. Telich describes her encounters with clients, “I share my stories and show my vulnerability. I know what it’s like not to have lights on.”
For clients facing pregnancy, C-CHWs like Telich skillfully provide their clients with a network of community resources to support a healthy pregnancy and delivery as well as continued access to ongoing medical care. Enabling access to available community services is only part of the story. The C-CHWs need near real time access to be there for their clients in their hour of need.
Delivering trusted data when it matters most
While trusted human connection and skills empower the C-CHW, data provides the fuel. HCAN relies on a centralized information management and reporting system that pushes alerts to C-CHWs when a client has a healthcare event and is admitted for care.
We rely on the information received from healthcare providers in order to do a good job for the clients. Having partnerships with organizations like The Health Collaborative, a Cincinnati-based electronic medical data exchange, quickly provides us with data we can trust thanks to their Master Patient Index, built on IBM’s InfoSphere Master Data Management. Through our integration with their system, client alerts pop into the C-CHWs’ case dashboard. This data enables them to reach out to that client very quickly.
Integrating data and decision-making leads to new skills
As their data analytics skills increase, some C-CHWs have expanded their career paths. For example, our data support specialist started as a certified community health worker. She transitioned to the role because her attention to detail, understanding of community and knowledge of data were the perfect fit. She can see and understand the data from the client’s side, from the community health worker’s perspective, and she catches issues or errors that a person without her experience wouldn’t see. Providing new opportunities for our employees, like they offer to our clients was an unexpected and positive benefit of our data reporting and alerts system.
Improving outcomes throughout the community
Why should you care about healthcare equality for expectant mothers? Addressing social determinants and providing prenatal care is not only good for the expectant mother and her child, it helps the community at large. The effects and costs of premature births are far reaching. For example, complications from preterm birth are the leading cause of death among children under five years of age, responsible for approximately 1 million deaths in 2015. Many survivors face a lifetime of disability, including learning disabilities and visual, and hearing problems. Individuals may also be afflicted with cerebral palsy. The costs associated with care and support strain struggling communities.
In 2007, the Institute of Medicine reported that the cost associated with premature birth in the United States was USD 26.2 billion each year. In today’s dollars, it is estimated to top USD 32 billion. For example:
- 611 million for early intervention services, programs for children under age three with disabilities and developmental delays
- 1.1 billion for special education services specially designed for children with disabilities ages three through 21
- 16.9 billion in medical and health care costs for the baby
- 1.9 billion in labor and delivery costs for mom
- 5.7 billion in lost work and pay for people born prematurely.
The whole person care provided by HCAN and its C-CHW addresses the blockers that effect the most vulnerable in their community. Building trust, depending on skills of their C-CHWs and relying on accurate and timely data is making an impact to Cincinnati and Hamilton County, one individual at a time.