Building Community Clinical Linkages Meeting Summary

Year: 2020
State: RI

Publicly Available: Yes
Billing and Reimbursement:
Evidence Generation:
Policy: Building partnerships, Identifying policy expertise within state, MCO contract language and reimbursement models
Sustainable Financing: Engaging state partners in general, Expand evidence base, How to engage and work with Medicaid, Including community-based CHWs, Education to HC orgs on payment options bundled etc., MCO or bundled payment reimbursement models, Documentation of how CHWs can work within care teams, Results from pilots studies etc. that aren't published in formal literature, ROI and bundled payment successes/challenges
Workforce Development: CDC expand CHW work into SDOH, CDC input on state-level strategic planning, Contacts for people in other states, Data sharing between social services and clinical teams, General other (including mention of “employment practices”)

Meeting notes, record of attendance, and next steps. Some key points:

  • Discussed the differences and roles of the Community Health Team (CHT) vs. HealthEquity Zone (HEZ).
  • The ultimate success of the CHT is the connection, communication and coordination as an extension of primary care.
  • Need to align and break down silos by thinking of CHWs in an assets-based way, as a way for healthcare to connect with existing social conditions and community health systems that drive health.
  • Providers would love the opportunity to read notes (from the CHW, PRS, or BHC) directly from an EHR in order to enhance coordination of care.
  • Data support is critical. In other states, the data showcased the impact of the opiate addiction MAT program, reductions in hospitalizations, and reductions in incarcerations and days in corrections had major ROI impact.
  • At least one health plan would strongly support CHT payment as part of a capitation rate to PCPs.

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