Building Successful ECM Teams: Early Lessons from Providers in the Field

NEIL A SOLOMON, MD, CO-FOUNDER, CMO & CHIEF COMPLIANCE OFFICER

The official launch of Enhanced Care Management (ECM) at the start of 2022 marked a watershed moment in the scale and ambition of California’s efforts to provide accessible, coordinated clinical and social services to individuals with complex health needs and related challenges. Moving beyond the Health Homes and Whole Person Care pilots, ECM is now a statewide Medi-Cal benefit that addresses the barriers to care and the fragmentation of the health system by bringing care directly to “populations of focus” in their communities, beyond the four walls of hospital and health care settings. Accordingly, Medi-Cal health plans are turning to locally based organizations to act as ECM providers who engage members, connect them to services available in their communities, and oversee the coordination of their care.

For ECM providers like MedZed, the challenges—and opportunities—to serving high-need, high-cost individuals are greater than ever. Much of our success will rest on our ability to rapidly build and deploy effective teams of community health workers (CHWs). How can we develop teams that can truly “meet members where they are” and successfully outreach and engage marginalized and underserved populations? How can we ensure staff are aware of and connected to all possible local resources? And how can we support and empower our teams as ECM expands and evolves?

Hiring Community-based Talent: Connection, Creativity, and Commitment

Providing ECM services is, by its very nature, a highly localized job, so it’s critical to build a team that is deeply rooted in the local community. Our CHWs are the backbone of our ECM program, and these individuals need to know their way around the community and how to relate to their members and to contacts at local organizations. That means they need be in touch with the local culture, environment, issues, and challenges. At a practical level, it helps if they are well-networked and connected to resources and organizations and know how to navigate among them.

Occasionally, finding and enrolling a member who is eligible for ECM can be a fairly straightforward process of calling, scheduling, and meeting. But many high-risk individuals can be hard to reach; they may be experiencing homelessness or are disconnected and disenfranchised from support systems, and may not respond to traditional outreach programs. In recruiting community health workers, we look for candidates who are creative, determined, and willing to be persistent at the “detective work” of locating members. They also need to be resilient and adaptable when working with a member who is distrustful, or uncooperative, or simply hard to motivate.

As an example, one of our CHWs in the Imperial Valley tried repeatedly to find a member experiencing homelessness: visiting her local hangouts, talking to support organizations she occasionally visited, and getting to know the member’s sister. The CHW’s relationship-building efforts with the sister made all the difference: one day the member came to the sister’s house and a disagreement ensued, and in that moment the sister reached out to the community health worker for help. The CHW arrived, and not only defused the situation, but managed to enroll the member and start working to help her with housing and other immediate needs that very day.

This CHW was successful because she was not only resourceful, but also deeply committed to doing absolutely everything possible to find and help the member. We find that highly effective CHWs come from a variety of backgrounds. Some are local college graduates with social work and related degrees who want to do grass roots work. Others have had family members or friends who have struggled with complex clinical and behavioral needs, and some have even themselves overcome such challenges. What they all have in common is that they can walk in the shoes of their members, they are connected to the community, and they are truly passionate about giving back.

Systematically Supporting CHWs: A Culture of Continuous Learning

For our field-based teams, every day brings new experiences and challenges. And CHWs typically face them alone, working one-on-one with a member. Their ability to manage these situations and come up with the best solutions depends in no small measure on how well equipped they are with critical knowledge and skills.

We begin preparing CHWs with foundational learning for new hires, e.g., locating and engaging members, cultural humility and competence, motivational interviewing and overcoming objections, communication skills and teamwork. Ongoing education sessions for the whole team offer the opportunity to delve into special topics in a way that allows newer and more seasoned staff to contribute their own perspectives and experiences and learn from one another. Topics range from clinical conditions (diabetes, other chronic diseases, mental health conditions and substance use disorders) to social supports (applying for state/federal programs, housing navigation researching and accessing resources) and field skills (safety, responding to crises).

Beyond training, we believe that bringing teams together at various levels creates important opportunities for shared learning. A daily statewide meeting covers ECM policies and procedures as well as upcoming changes, giving staff insight into new program requirements or expectations.  In addition, local market daily huddles provide invaluable forums for staff in each geographic area to share new local resources they have discovered, as well as best practices and successful strategies they’ve employed to address challenges and engage in collaborative problem solving.  

Looking Ahead: Ramping up Resources

It is still early days for ECM, but our experiences thus far have helped refine our delivery model and the infrastructure to support it. Our locally based recruiting together with centralized systems have positioned us to replicate our model quickly and across new geographies. At MedZed, we are committed to providing personalized care rooted in the community and helping Medi-Cal’s growing high need population live healthier lives.