The Bridge Program
- Need: Access to primary medical, dental, and mental health services for rural Appalachia Kentuckians.
- Intervention: Community Health Workers provide outreach, education, navigation, and care coordination services to 5 counties in the Western Appalachian area of Kentucky through The Bridge Program.
- Results: Emergency room visits have decreased throughout the course of the program and referrals to healthcare services have increased. Increases in self-efficacy and decreases in A1c levels have reached statistical significance.
Geographic and travel barriers, poverty, lack of providers, and lack of medical insurance all negatively affect the health status of rural Kentuckians in Bath, Menifee, Morgan, Rowan, and Montgomery counties. This region located in Western Appalachia has a high rate of death from chronic disease that directly relates to high rates of risk-related behaviors and conditions such smoking, obesity, lack of physical activity, and lack of regular preventive medical care.
To help improve access to care, especially for the uninsured and underinsured, the Montgomery County Health Department created the Western Appalachian Health Care Access Consortium. This program utilizes a home visitation model, employing Community Health Workers (CHWs) to help clients navigate the healthcare system, find a medical home, and establish a payer source for services in both local and immigrant populations. The CHW program is known as "The Bridge."
CHWs are educated on numerous chronic conditions such as mental health, hypertension, asthma, and diabetes. A curriculum that covers home visitation safety, communication, literacy, documentation and data collection, and community resources is developed and approved by the Appalachian Kentucky Health Care Access Network. The curriculum courses cover all core competencies as approved by the Kentucky CHW Workgroup. All CHWs must participate in the evidence-based Stanford Chronic Disease Self-Management leader training to learn how to help clients increase their self-efficacy in managing their own chronic diseases.
This program received support from a 2012-2015 Federal Office of Rural Health Policy Rural Health Care Services Outreach grant.
Community Health Worker outreach efforts include:
- Conducting home visits with clients
- Connecting client with resources including prescriptions, food, and assistance with utilities
- Making appropriate referrals to meet clients’ needs and accompanying them to appointments when necessary
- Providing classes in community settings
- Enlisting existing volunteer community members to serve as CHWs
- Advocating on behalf of the clients for needs within the community
- Providing culturally and linguistically-appropriate education
The Western Appalachian Health Care Access Consortium created a CHW curriculum based on the Core Competencies established by the Kentucky State CHW workgroup. In addition to training, they provide technical assistance in developing, sustaining, and evaluating CHW Programs across the state.
The Western Appalachian Health Care Access Consortium has increased the visibility of CHWs, healthcare access, and the health status of clients as a whole. Below are specific results from the program:
- Statistically significant decrease in A1c levels for clients
- Statistically significant decrease in systolic blood pressure
- Statistically significant improvement in self-efficacy scores
- 16.4% increase of clients who have a primary care provider (as of 2013)
- 39.2% of clients are meeting all their goals in their care plan
- Emergency room visits continue to decrease
- 19.37% of clients have overcome difficulties obtaining housing, utilities, food, or clothing (as of 2013)
- Overall, there is 100% client satisfaction with a CHW. The average score for client satisfaction is 4.92 where a score of 5 indicates highly satisfied.
- CHWs have proven to be a return on investment as they have helped to decrease the cost of uncompensated care and improper healthcare utilization
Western Appalachian Health Care Access Consortium is featured in RHIhub’s Rural Diabetes Prevention and Management Toolkit Program Clearinghouse.
The Bridge Program is featured in New America Media's article "Kentucky’s Community Health Workers Meet Obstacles for Better Health," 2017.
Challenges faced by the program include:
- Loss of the state insurance exchange KYNECT, lack of insurance providers on the Exchange for this service region, and rising costs of premiums
- Loss of the utilization of CHWs as “KYNECTORS” to assist clients with enrollment
- Loss of the KYNECT website to assist clients for Medicaid expansion
- Lack of public transportation system
- Providers’ understanding of CHWs being a part of a value-based payment system
- Lack of providers willing to serve an uninsured or underinsured population
- No coverage for certain vision and dental procedures for the Medicare population
- Eligibility of Latino patients for insurance coverage under ACA, but grant dollars were shifted to provide coverage after eligible patients were enrolled
- Establish an evaluation plan and know what you want to measure to prove impact and success. Evaluation results in sustainability.
- Be aware of the following before creating a program:
- Data on population demographics and health disparities
- Knowledge and awareness of CHWs by local providers
- Community resources for both healthcare and social services
- Healthcare delivery systems in the region
Community health workers
Wellness, health promotion, and disease prevention
September 2, 2015
November 7, 2017
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.