ALTERNATIVE HEALTH CARE
Workers help at-risk communities connect with resources they need
“The members trust me because they see I’m from the same community. They can see that I’m not just sitting in the office. They can see me out working in the community.”
CAROL WITCHER INDEPENDENT CARE HEALTH PLAN TEACHER
The smell of freshly cooked egg whites against unsalted quinoa greets students as they arrive at Carol Witcher’s weekly diabetes class.
Most of the students are older, lower-income adults who may be hesitant in dealing with a doctor, Witcher said. But they feel comfortable speaking openly in her class at the Independent Care Health Plan headquarters in Milwaukee, where they can ask questions and be exposed to material that helps them better understand their disease and how to manage it.
Witcher is an example of an emerging but still informal cate-
gory of health care job, the “community health worker” — someone who can bridge the gap between hard-to-reach patients and the resources and health
care professionals who may be able to help them.
“The key is that the person that’s teaching looks like everyone else in the room,” said Marvin Jones, the chef who prepares the healthy breakfast each class period.
This alternative approach to health care is becoming more widespread in the United States, gaining support from groups that say it can help control rising health care costs and engage with people the health care system otherwise struggles to reach. It is officially recognized as a job classification in some states, but Wisconsin is not yet among them.
Central to the approach are workers like Witcher. Community health workers often are trusted members of the communities they work in and are able to connect residents to health and social services that are specific to their needs.
Their jobs range from educating people on getting certain cancer screenings to teaching them how to eat healthier or exercise more, working with social workers to help someone with asthma get better housing and advocating for policies that improve air quality in the community.
Because these workers are familiar with the communities where they work, they have shared experiences and often
understand their residents better than a health professional with multiple degrees would.
That common ground and understanding can make them more approachable than even the friendliest doctor.
“The members trust me because they see I’m from the same community,” Witcher said. “They can see that I’m not just sitting in the office. They can see me out working in the community.”
As health care costs rise, advocates for community health workers point to the field as a way to reduce health care spending.
Of the $3.2 trillion that the U.S. spent on health care in 2015, hospital care and physician and clinical services accounted for 52% of that spending, data from the Center for Medicare & Medicaid Services show.
Where the country can save money, advocates say, is in also addressing social and economic challenges, such as racism and poverty, that affect health, often more so than medical challenges.
Groups such as UniteMKE, a community health advocacy organization funded by the state and private donations, encourage the use of community health workers to talk to residents and find out their needs both inside and outside hospital and clinic walls.
Whether those needs
are housing, employment, or referrals to doctors or social services, community health workers act as a hub that can point residents to the services they need.
“When you work on the other areas around a person’s life, their health improves with it,” said Bria Grant, executive director of UniteMKE.
U.S. health policy tends to overlook people’s needs outside the typical health care system, but those needs can significantly impact health, the National Academy of Medicine wrote in a 2016 report.
At least three organizations — UniteMKE, United Voices and the Wisconsin Community Health Worker Alliance — are leading the effort to standardize the use of community health workers in Wisconsin.
The groups, which are funded through grants or government programs, specialize in different areas, such as training or tracking health outcomes.
Their initiatives include establishing a way to credential new employees, securing stable funding for the community health workforce and developing common qualifications that all community health workers should have.
Witcher, 64, has been a community health worker for 20 years. She originally was a preschool
teacher but changed fields after taking training required for that job, where she learned about community health workers.
“I saw that’s what I wanted to do,” she said. “I don’t believe people should die just because they’re poverty-stricken.”
In her diabetes class, she and her co-teacher, Jarvis West, teach students how to develop good eating habits, including preparing and freezing healthful meals a week ahead so they don’t resort to fast food.
When she’s not teaching, Witcher visits people enrolled in Independent Care Health Plan, or iCare, coverage at home to make sure they’re keeping up with treatment plans, recruiting people who could benefit from joining the health plan and going to health fairs where iCare members can learn of available resources.
While she is not a college graduate, she received training through the Milwaukee Area Health Education Center’s community health worker program, which teaches new workers about public health terms and communications skills they will need on the job, among other things. The center houses the Wisconsin Community Health Worker Alliance.
Witcher also took a
course through the Wisconsin Institute for Healthy Aging so she could teach the Healthy Living with Diabetes class at iCare.
Because there is no degree or certification for community health workers in Wisconsin, many newcomers to the field gain experience through training programs like the ones Witcher went through. Others may receive onthe-job training or use their previous professional or life experiences to help their residents.
Along with iCare, Wisconsin employers of community health workers include Ascension Columbia St. Mary’s and Fight Asthma Milwaukee Allies.
State Rep. Daniel Riemer (D-Milwaukee) is drafting legislation with input from the Wisconsin Community Health Worker Alliance to propose a statewide advisory council that would establish guidelines for community health workers to be certified.
“Community health workers are out in the community spreading information, building relationships with folks, helping them get to a place where they’re living better, living longer and living healthier,” Riemer said. “This is a step in the direction of better health for folks in communities all over the state of Wisconsin.”