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PCIC, Humana and the University of Houston CHW Join Forces to Inspire Change

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In May 2020, leadership from PCIC, Humana and the University of Houston Community Health Worker Initiative (UH CHWI) presented an innovative, collaborative model of care at the virtual Collective Impact Forum. In the presentation, Tray Cockerell (Humana), Kallol Mahata (PCIC), and Dona Stelzig (UH CHW) spoke about their project’s goals and their organizations’ shared vision for revitalizing healthcare systems and combating current barriers to quality treatment.

In Harris County, 18% of residents lack consistent access to healthy foods, and 18% report their health status as “poor”, while over 34% are obese.
This represents a gross misalignment of resources, and improper health behaviors in one of the nation’s largest and most diverse communities. Thus, the mission of the partnership is four-fold:

  • improve patients’ health outcomes while reducing medical expenses,
  • influence public policy and legislation to allow for public health data sharing and other mechanisms of collaborative health practices,
  • integrate Social Determinants of Health (SDoH) and health- related social needs into a care panning structure to bridge gaps in treatment, and
  • maintain cross-sector community partnerships to support a combined model of social and medical care for patients.
Humana’s Bold Goals strategy aims to implement these ideas in the communities they serve to improve health outcomes by 20%. To work towards their goals, Humana collaborated with PCIC to tailor their Unified Care Continuum Platform (UCCP) for Humana’s members. The UCCP will provide a cloud-based medium to record patient information, share public health data, construct an individual- specific care plan based on a Values-Based Model, make referrals to social service and medical agencies, and track patient outcomes in real time.

Utilizing this platform are Texas- certified Community Health Workers (CHWs) within the UH CHW program who serve as a conduit between community members and solutions in a complex healthcare system. These CHWs use the UCCP to perform direct intervention services for patients, while also serving as public health educators and informal counselors for vulnerable populations.

PCIC is excited to see this effort’s impact be realized and hope to lead efforts such as this to shape health practices on an individual, community and national level moving. Click the video link below to learn more:

  • Last modified on Friday, 28 August 2020 16:21

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