By Bukata Hayes, VP of Racial and Health Equity, Blue Cross and Blue Shield of Minnesota
Linking Housing and Health Equity with Community Health Workers
Most of a person’s health is determined outside of a doctor’s office. 20% of health is influenced by clinical care and genetics. The remaining 80% is the result of a person’s physical environment, health behaviors, and social economic factors like income, food insecurity, quality education access, community safety, and housing. Of these factors, housing is one of the most researched. An overwhelming amount of data confirms the lived experience of many: stable, safe, and affordable housing improves health.
When it comes to challenges in housing, it’s also well documented that Black, Indigenous, and people of color (BIPOC) – including Latin, Asian, Pacific Islander, and others – are disproportionately impacted. Like many systems in the United States, housing access is built upon a history of structural racism, resulting in tremendous inequities. That’s why today we see BIPOC households more likely than white households to be low-income renters, and BIPOC households facing disproportionate barriers to paying rent compared to white households. When that struggle turns into homelessness or foreclosure, research shows an increase in adverse health outcomes like depression, anxiety, alcohol use, psychological distress, and suicide.
One partnership which Blue Cross and Blue Shield of Minnesota (Blue Cross) is investing in, is building, testing, and expanding models to transform existing healthcare infrastructure to address social determinants of health and close racial and health inequities.
The goal of this partnership is to connect more people in the Mankato area to Community Health Workers (CHW), who help bridge the gap between health outcomes and the underlying social conditions that impact those outcomes – including housing.
Strength in collaboration
Mankato Clinic, Blue Cross and WellShare International are working together to address barriers to health in the Mankato area. Ceceli Polzin, community relations manager at the Mankato Clinic wants to better equip patients outside of the clinic setting for health success. “If they’re struggling with [social determinants of health], they’re not going to be focusing on their own health, family’s health, or a chronic disease. What we’re hoping is that if we can bridge the gap and help our patients with some of those barriers out in the community, they will be healthier.” That is the role of a CHW.
Key to this partnership is WellShare. WellShare is internationally recognized among health systems as an expert in the recruitment and training of CHWs and is regarded as the pioneer of the CHW model in Minnesota. They have trained over 6,000 CHWs to provide evidence-based services for reducing health disparities, and their health education materials are used by providers around the world.
“WellShare’s commitment to social justice and racial equity drove us to open this CHW hub in Mankato,” said Evan Curtin, Director of the Mankato Community Health Worker Hub. “Marginalized communities in rural areas deserve equal access to healthcare and there are significant, unique barriers to this outside the Twin Cities.”
In partnership with WellShare, the Mankato Clinic has incorporated a patient screening tool related to social determinants of health. This helps identify patients who may need greater support in areas such as food security, childcare, social connection, transportation, utilities, basic needs, and housing. If patients indicate that they are experiencing hardship in any of these areas, including unstable or unaffordable housing or homelessness, clinic staff connect them to WellShare’s CHWs, who provide wraparound support including housing assistance or transitional housing resources.
One such patient was able to utilize this resource and achieve positive health impacts and stable housing.
Upon moving to Minnesota from Illinois, Susan found herself with a complex medical diagnosis that required more care. Susan worked with local social workers to try to obtain a Community Access for Disability Inclusion (CADI) waiver, which provides home and community-based services to people with disabilities who require the level of care more on par with a nursing facility. This program helps a person live independently in their community, over a longer-term.
Unfortunately, inaccurate assumptions were made about Susan based on her race and history. This led to Susan being unable to receive a CADI waiver. WellShare’s CHWs advocated for Susan within the complex system interactions of government and healthcare providers. The effort resulted in Susan obtaining safe housing in an assisted living facility where she could receive the care she needed in a community setting.
Blue Cross’ commitment
Supporting positive health outcomes requires holistic solutions. As a health care organization, Blue Cross recognizes that supporting a robust infrastructure for CHWs is an essential component of improving community health throughout the state. That is why it has been focused on building out Minnesota’s CHW environment over the past 15 years.
Part of this work includes supporting policy solutions that elevate the important role CHWs play in the health care system. Early in this legislative session, the governor proposed investing $1.5 million in this biennium for the Minnesota Department of Health to work with the Minnesota Community Health Workers Alliance to expand, strengthen, and evaluate Minnesota’s CHW workforce in the metro and in Greater Minnesota. That budget proposal is currently making its way through the legislative process.
CHW’s community work– including providing pathways to the solid foundation of a stable home – has significant impacts on health.
The Mankato Clinic partnership is tackling barriers to health while building the infrastructure needed both in our communities and within our healthcare system. Blue Cross is committed to eliminating racial and health inequities in a way that is financially sustainable, deeply impactful, and systemically transformative.