Can Community Health Workers eliminate health disparities? Horizon thinks so

Health care is often reduced to a few simple premises. Going to a doctor or hospital. Explaining and then treating a physical ailment. Checking to see the ailment is cured.

For many people, that formula isn’t enough. That’s why Horizon Blue Cross Blue Shield of New Jersey took a bold step in 2017 and started going deeper than just the perceived basics of health care.

They started addressing the many nonmedical factors, experiences and situations that impact someone’s overall health. They looked at where people live or work, their access to healthy foods and what causes them stress, among other things — all issues that connect to and result in health disparities. To tackle disparities and promote health equity, they created Horizon Neighbors in Health.

“We have to recognize that so many of the people we serve struggle to meet basic needs,” said Valerie Harr, senior director of community health at Horizon. “These health inequities create underlying issues that make it hard, if not impossible, to manage a chronic disease or get someone on a path to prevention, wellness and health.”

Harr knows a thing or two about helping traditionally underresourced communities, having served as the Medicaid director in the New Jersey Department of Human Services.

Initially, a Newark-based pilot program connected participating Horizon members to social supports like healthy food, transportation or job training. This resulted in dramatic improvements in mental health and a lower total cost of care. Based on the pilot’s successes, in 2020 Horizon created a statewide Neighbors in Health program.

Nearly 13,000 Horizon members have enrolled in the program, with over 6,000 having graduated (meaning their program specific needs were met). This includes work done directly with public employees and members of the State Health Benefits Plan, particularly in and around Trenton.

Neighbors in Health utilizes nearly 50 Community Health Workers across all 21 New Jersey counties. Community Health Workers come from the communities where they work. They are, quite literally, neighbors with program participants and share life experiences and understand their challenges.

Maria Alvarado is a perfect example. Born in Vineland, Alvarado found that she easily developed a rapport with people. She started as a Certified Nurse Assistant at an adult medical day care. Eventually, she began working at Inspira Medical Center, a Neighbors in Health partner located in Vineland.

In 2021, Alvarado became a Community Health Worker. Her day typically starts by calling eligible program participants. She engages them on issues impacting their health and how Neighbors in Health can assist. From there, she sets up a 20-minute assessment, usually in person. Over the last year and a half, Alvarado has offered help to over a thousand people.

“I know their doctor and their practice, which puts people at ease,” said Alvarado of her initial contact with potential program participants. Speaking Spanish is another way she connects with program members, as nearly one-third of Cumberland County’s population is Hispanic. She has personally escorted program members to see counselors and directed members to physicians’ offices rather than going to the emergency room, which helps them with their bills.

One Friday, Alvarado received a call from a woman recovering from leg wounds that needed daily cleaning and bandaging. The woman’s nursing aid was unable to come over, leaving her without bandages or someone to assist her in cleaning her wounds.

Alvarado sprang into action. She provided the necessary bandages and clean water to help with the woman’s legs. She then added something extra to brighten the woman’s day.

“I brought her flowers,” Alvarado said. “She said it was the first time she had ever gotten flowers.”

Neighbors in Health’s holistic approach addresses health inequities and meets Horizon members’ needs that fall outside of the normal considerations of health care. Moreover, Neighbors in Health’s method of direct home care — of literally meeting people where they are — is proving to be a catalyst for providing more affordable, accessible health insurance. Several studies have noted that this type of home care often leads to “lower readmission rates, lower payer costs and higher patient satisfaction.”

While successful, more work must be done to support these kinds of programs. A Penn Center for Community Health Workers (a Neighbors in Health partner) report listed several concepts needed just to better support Community Health Workers alone. They include recruiting candidates via community-based avenues and clear, inclusive job descriptions, supporting Community Health Workers’ self-care and mental/emotional health and ensuring sustainable financing for programs.

Neighbors in Health has laid the groundwork for addressing disparities in health and building health equity. The work of people like Maria Alvarado is truly changing lives. Meanwhile, Horizon’s ingenuity in addressing health inequity and providing direct home care has been a catalyst for systemic change in health care delivery.

For more information about Horizon Neighbors in Health, click here.

Inspira Medical Center and Penn Center for Community Health Workers are independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.

Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross Blue Shield Association. The Horizon name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey.