2016 was certainly a year of big changes for BHT. Our work as the backbone organization for our region’s Accountable Community of Health has picked up speed since the announcement that the state has reached agreement in principle on the Medicaid 1115 Demonstration Waiver, creating an opportunity to transform the Medicaid delivery system by providing flexible dollars to invest in needed community infrastructure that supports health and community. As we built out this work, we were intent on identifying community infrastructure gaps, which we assessed through several community design and linkage mapping sessions targeting Social Determinants of Health and Population Health improvement goals. The more we learned about the landscape in our region, the more important it seemed for Better Health Together to carve out a unique and value added role in the community.
Better Health Together started out 2016 with a goal of growing our Community Health Worker (CHW) task force through our Community Cares programs, among them Health Homes, Family Assessment Response and Hot Spotters. The use of CHWs has proven to be a successful model in saving dollars by reducing unnecessary and/or inappropriate use of the Emergency Room and other health expenses by connecting clients to appropriate care and and support at the right time. However, we learned a lot about CHW strategies throughout our own work and these community conversations, including it that can be most effective if CHWs are placed at locations where other services are being delivered, for instance at a supportive housing complex, a clinic or at a community service organization. After careful consideration and conversation with our partners, we chose to close out our CHW care coordination services for Hot Spotters and FAR as of December 2016. This was a tough decision, but made much easier by the incredible partnerships in the community which are ensuring this work remains supported.
The Hot Spotter program has found a new home with Volunteers of America who, having just opened 50 new units of supportive housing at the Merilee, stand to make a big impact in the lives of chronically homeless individuals by providing CHW support the stability of newly housed individuals. The Hot Spotter program not only advocates and improves outcomes for some of our most vulnerable, but the incredible partnerships through the program also demonstrate our community’s commitment to collaborate on tackling our most complex challenges. Hot Spotters closed 2016 serving 120 clients in total, and Community Health Worker support for those clients helped 59 secure housing, 30 obtain a primary care provider, 60 obtain chemical dependency or mental health services, and 12 increase their income.
Thanks to generous funding from Empire Health Foundation and United Way of Spokane County Better Health Together employed one FAR CHW in 2016, who worked in tandem with a Children’s Administration social worker to support families at risk for separation due to parental neglect. The families we work with received individualized coaching and encouragement from their CHW with referrals to needed health and social supports to keep their family healthy and united. 100% of all clients were enrolled in health insurance, thanks to a strong partnership with the Navigator Network. Additionally, families received referrals to oral health, mental health, housing, parenting classes, domestic violence, basic needs, vision, and substance use disorder. We are immensely proud that of all the families we worked with over 80% were able to remain united. Of course we have to give great thanks to our team of passionate Community Health Workers who gave their hearts to supporting these clients. We are incredibly honored to have had the opportunity to serve and support these individuals and families.