Health and Housing in the Northwest

Using Community Health Workers to Bridge Housing and Health for Low Income Communities

From 2014-2017 Mercy Housing Northwest (MHNW) and the King County Housing & Health Partnership made significant headway testing promising practices for using Community Health Workers in public and affordable housing communities. MHNW embedded 5 Community Health Workers (CHWs) in 7 affordable and public housing sites in Seattle and King County.

King County is Washington’s most populous, with 2.1 million people and over 400,000 Medicaid beneficiaries. Our area is home to growing numbers of immigrants and refugees and MHNW was deliberate about hiring CHWs with the language skills and cultural competence to connect with low-income immigrant and refugee communities.

MHNW’s approach leveraged effective partnerships with state and local government leaders, public housing authorities, nonprofit housing organizations, Medicaid managed care plans, philanthropic organizations, community based organizations, and Federally Qualified Health Centers to make the case for a truly community oriented population health strategy focused on families in affordable and public housing. Over 3,000 low-income residents participated in the CHW program each year.

We are eager to share our experience with other community development organizations and Community Health Worker champions from a variety of backgrounds. Our final report details lessons learned and provides a narrative case study of the evolution of this partnership.

Summary of Lessons Learned:

  • Biggest success: Engagement of underserved, vulnerable households.
  • Biggest aspiration: More formal partnerships with health providers.
  • Housing-health data integration: Integration of Medicaid claims data- which provides comprehensive cost and clinical treatment information for all Medicaid users- with the individual and household-level data collected as part of affordable/public housing compliance could greatly spur collaboration between these two sectors. An integrated housing-health database (or broader “social determinant database”) will show baseline health data on housing residents that will identify areas of need and shape more focused interventions, and creates capacity to measure the success of interventions.
  • State-level institutional support for Community Health Workers: Community Health Workers (CHWs) are widely valued “philosophically” by health system stakeholders, but system supports (common standards for roles, reimbursement and training) are needed for this workforce to be stable and effective.
  • Synchronize non-clinical health resources: A key strategy to expand upstream health efforts is to coordinate and braid funding and other resources across the social determinants. Washington State could leverage state purchasing power to mitigate fragmented health payment incentives. Local philanthropic, governmental, and housing entities could braid resources and make community investments in a more systemic and coordinated fashion.

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Community health workers can improve health outcomes while achieving significant cost savings, particularly with underserved populations.

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