The HealthPartners Institute is embarking on a study to help determine whether health workers who encourage people to live healthier lives can drive down long-term emergency or hospitalization costs for heart ailments.

Many health systems and public health agencies are employing community health workers who meet clients at home and coach them on improving their medication compliance and diets and exercising more, as well as pointing them to social services that deal with larger issues such as housing and employment.

The problem is, it is tough to know if these efforts ultimately lower health care costs. Health insurance usually does not pay for these services, and if it does, the reimbursement rates are low.

"One of the reasons that these types of community providers are not used more often is because health systems aren't designed to track their efforts or to estimate the benefit versus the cost," said Dr. Bjorn Westgard, emergency medicine research director at HealthPartners' Regions Hospital and principal investigator on the study.

Under a $1.9 million grant awarded by the National Institute on Aging, part of the National Institutes of Health in Bethesda, Md., the four-year study will look at the effectiveness of community health workers in improving heart health.

Using patient data from metro hospitals, the study will first identify pockets of the Twin Cities where residents show signs of heart disease risk factors, including obesity, high blood pressure, cholesterol issues and diabetes.

This type of research is part of a trend in public health known as "hot-spotting," or looking for clusters of illness or poor health and then targeting resources to those neighborhoods.

"There's a lot of illness that exists outside the clinic that we are unable to see or target or improve upon because it never comes through the doors," said Westgard. "The community health workers could potentially intervene in those situations."

Field is growing

The community health worker field is growing in Minnesota, especially as health care grapples with poor health outcomes for minority groups. Many health workers come from the communities that they are trying to help.

"Their real skill set is representing and being knowledgeable about the communities they reside in," said Renae Oswald-Anderson, interim executive director at the Minnesota Community Health Worker Alliance. "They really bring the cultural competence."

Minnesota has several programs that train community health workers to obtain certification for the work. Although that is not required, certification is needed to bill Medical Assistance. About 700 people have become certified in Minnesota.

"We are getting more incoming students who are interested in a certification program," said Cindy Carow-Schiebe, a faculty member at Normandale Community College in Bloomington, which has a training program that typically can be completed in a year.

She said health care organizations are increasingly looking for people who have gone through the training.

Oswald-Anderson said the HealthPartners research could prove valuable for the field because it would "track early interventions to helping people improve their health status and not use more expensive options like the emergency room."

Westgard's study will use sophisticated computer modeling to estimate the benefits of the workers over several years' time, which could provide the basis for determining new ways to pay for interventions.

"I firmly believe that there is a business case for public health," he said. "We need to learn how to see populations outside of the hospital."