A groundbreaking community-based initiative in Longview, Texas, is gaining local, state and national recognition in its mission to reduce the need for use of emergency acute care services by high-risk community members. Through a grant awarded by the Episcopal Health Foundation, Greater Longview Optimal Wellness (GLOW) was established in 2021 to improve access to health and wellness services for the community.
The mission of GLOW is to identify frequent users of acute emergency services (for example, 911 and emergency departments) for nonemergent purposes and develop a strategy for streamlining the navigation of community organization services. GLOW hopes to alleviate unmet needs by addressing social determinants of health and using community health paramedicine. For instance, Longview has a paramedicine worker, licensed as both a paramedic and a registered nurse, who provides thorough assessments and interventions in the field. This initiative has proven to be no easy task, but results so far have garnered the attention of state and national representatives to better understand this work and its challenges.
A WILLINGNESS TO DISRUPT THE STATUS QUO
CHRISTUS Good Shepherd Health System in Longview is one of eight community partners that make up the GLOW initiative. Other partner members include the city of Longview, Gregg County, Greater Longview United Way, Community Healthcore, Special Health Resources of Texas, Wellness Pointe and Longview Regional Medical Center. All partner organizations have equal representation on the GLOW steering committee, and an executive leader from each partner organization forms the governing board.
Amy Hooten, Longview Fire Department's EMS section chief and GLOW Steering Committee chair, has been a speaker at state and federal engagements in Austin and Washington, D.C., about GLOW's work, the importance of its mission, current barriers and how Texas' six Accountable Communities for Health — organizations that coordinate on health care and social needs in a region — can provide pathways to address social determinants of health.
On the surface, the mission is simple, but there are many caveats that have required out-of-the-box approaches and a willingness to disrupt the status quo. The first challenge of GLOW was to establish an overall vision of how the grant could be put to its best use in our community, engage partners that could make it happen and create models for effective patient-level communication across entities.
Initial work-plan brainstorming centered on how to best use the grant to meet the needs of vulnerable populations, improve wellness, better understand the impact of social determinants of health, and be responsible stewards to our community and funders. With the unique perspective of each partner organization, GLOW is meeting the challenges of these goals.
UNDERSTANDING COMMUNITY USE AND IMPACT
Initial research for GLOW included determining how to define and identify high utilizers and understand the impact on the community. Research showed approximately 50 individuals in the community had accessed 911 services for nonemergent needs at least eight times in the most recent 12 months. Using an average of this data, it was determined that each call to 911 equated to approximately $1,500 of tax-payer funding for EMS response (not considering additional costs for related emergency department visits). Initial case studies showed patrons had difficulty understanding and navigating outpatient services, had social determinants of health that created barriers to accessing needed services, and responded favorably when community partners collaborated with their consent and on their behalf.
Each partner organization has been encouraged to develop internal workflow models to identify patrons enrolled in the GLOW program, develop a list of services offered by their agency applicable to the targeted populations and create processes that expedite interventions (for example, use of teleservices, creation of same-day/next-day appointments, transportation assistance, etc.). The GLOW work model is pivotal for all partner agencies communicating and working together.
Once the vision and mission were defined, the main challenge was to determine how organizations could advocate and communicate using patient-level details while still adhering to HIPAA regulations. This was done by creating a single consent form that includes all partner agencies. After high-utilizing patrons are identified, any partner organization can explain the program and ask if the patient would like to complete the consent with all partner agencies.
GLOW is also implementing the use of technology to facilitate streamlined communication on behalf of patrons. Through the use of a HIPAA-compliant, secure and easy-to-use application, teams across organizations can be united to provide a single unified patient communication channel. All partner organizations have access to the software program with the ability to alert each other on patient encounters and can then bring partner organizations to assist the patient, as needed.
For example, for a patient that has provided signed consent, if they arrive at the emergency department — but are in need of services better offered by a partner organization — the care team in the emergency department can add that specific partner agency to the patient's channel in the app to alert them of the encounter. From there, the department can then communicate with that partner to coordinate care with the patient going forward. This allows partners to collaborate on the patient's behalf to ensure adherence to care plans, proactively mitigate potential barriers (for example, transportation needs, prescription assistance and more) and improve awareness of social determinants of health that may factor into overall health and wellness. The implementation of a secure, interorganizational communication application has been key in streamlining communication and is an integral part of GLOW's success.
HARDWIRING WORKFLOW PROCESSES
Closing in on its second full grant program year, GLOW's goals have centered on hardwiring workflow processes within each partner agency. Steps in the GLOW protocol are as follows:
- Referral is received by the city of Longview staff supporting GLOW.
- A report is created with the EMS electronic platform.
- The GLOW coordinator reviews the report and activates GLOW.
- Consent process is initiated.
- Baseline screening using a tool to assess and measure nonmedical drivers of health.
- A patient care record is created, priority of intervention determined from the nonmedical drivers of health screening instrument, and approved by the community health paramedic.
- Individualized interventions are initiated for the GLOW participant.
Each partner must determine how patients will be identified as patrons of GLOW, and how their internal workflows can be amended to best meet individualized interventions needed for the GLOW participant. In initial case studies, interventions have included providing points of daily contact with the community health paramedicine nurse, arranging for medications, establishing patients with primary health care providers, providing transportation to follow-up appointments, facilitating contact with family members, arranging placement into long-term care facilities and connecting patients with mental health services. Early data shows these targeted interventions have the potential to decrease nonemergency use of acute care services by over half in these at-risk populations. Furthermore, due to the governing structure and funding supporting involved partners, patients are routed to the organization that can best support their needs, regardless of the patient's ability to pay. This structure allows for equitable care for patients.
To better understand the impact of GLOW from initial data provided in case studies, the Episcopal Health Foundation expanded the initial grant to fund a formal research study through the University of Texas at Tyler. The study is being processed through the university and partner agency internal review boards. The study will aim to identify interventions that are most effective in mitigating 911 calls, admissions to the hospital and perceived positive impacts on the health and well-being of GLOW participants based on pre- and post-nonmedical drivers of health screening scores. With this data, the program will define the business case for other potential funders. By having a clear understanding of the return on investment and financial impact on insurance companies and community members, GLOW can progress beyond the initial grant into a model for sustainable funding.
GAINING MOMENTUM FOR THE FUTURE
As the work of GLOW continues to gain recognition and results, Aetna CVS Health offered a grant to fund multiple nursing schools throughout the East Texas region to help with the work of GLOW. With this assistance, local nursing school programs can incorporate a clinical experience into the curriculum of mental health and population health courses. Through these partnerships, nursing students gain clinical hours by shadowing with the GLOW coordinator, the community health paramedicine nurse, hospital case managers and other partner organization personnel. In this capacity, the student nurses are trained in completing nonmedical drivers of health assessments and become well-acclimated with services offered by partners and community organizations. This relationship is mutually beneficial in both expanding the knowledge of students about the benefits and challenges of population health and in expanding the work and reach of GLOW.
While GLOW is still somewhat new, the response and engagement within the community have been extremely positive. This is attributable to the executive leadership of each partner organization committing to the mission of GLOW and supporting collaboration over competition.
The devastation to health care entities during the COVID-19 pandemic is well-known, but for Longview this proved to be an opportunity to highlight the abilities of community service organizations to form purposeful partnerships, setting a firm foundation for the success of GLOW in the years to come.
AMIE COCKRELL is the director of quality management for CHRISTUS Good Shepherd Health System in Longview, Texas.