Rural health network development program - project goals: strengthen the organizational and infrastructure capacity of the pacs consortium to implement community health worker (CHW) based models of…

Rural health network development program - project goals: strengthen the organizational and infrastructure capacity of the pacs consortium to implement community health worker (CHW) based models of chronic care management (CCM), to demonstrate that these models improve health and reduce cost, especially for individuals who struggle to control their chronic conditions, and to achieve CHW sustainability in SE OH through exploration and/or development of insurance reimbursable models. Grant focus areas: numbers 1,2,3 target patient population: high-risk patients identified both clinically and by state health plans who live in project counties (rural appalachian ohio) network members: 20 members, 3 state health plans, 7 local health departments, 1 fqhc, 2 universities, 7 regional agencies with a stake in CHW sustainability pacs partners are submitting this network development grant to build on pacs successful implementation of the pathways hub model to sustain community health workers by expanding the geographic area reach, including chronic diseases eligible for CHW support beyond diabetes to include congestive heart failure, copd, falls and patient engagement, and to increase pacs membership to include all state health plans and other appropriate partners. The project will to lead to reimbursement by insurers for certain CHW services, creating new jobs and a sustainable CHW workforce. We expect this service to improve the health of residents in the project counties, improve the system of care, and reduce healthcare costs. Legislative aims: - aim #2: expand access to, coordinate, and improve the quality of essential health care services. Rural eligibility: all project counties meet the rural eligibility as identified on the hrsa rural health grants eligibility analyzer (https://data.hrsa.GOV/tools/rural-health) request for funding preference HHC and consortium members request funding preference based on the following qualifications outlined in section 330 a (H) of the public health serv ices act (42 U.S.C. 254H(3) and explained in attachment 12 qualification 1: health professional shortage area (7 counties) qualification 2: medically underserved community/populations (15 MUA's) qualification 3: focus on primary care, wellness, and prevention strategies (use of CHW's to improve primary health care and prevent falls)