Community Health Workers & Pharmacists: Their Frontline Role in the Response to COVID-19

Cait Ellis (00:00:00):

Thank you so much. Good afternoon everyone. I'm Cait Ellis, program manager at the National Institute for Healthcare Management foundation. On behalf of NIHCM, thank you for joining us today to explore this important topic. Our goal is to share information on the unique frontline role the community health workers and pharmacists play in the public health response to COVID-19 and to outline opportunities and strategies to support these workers and strengthen their ability to improve public health and promote health equity going forward.

Cait Ellis (00:00:33):

The community health worker workforce is diverse, growing and drawing attention to its ability to address determinants of poor health. As trusted resources embedded in our communities, community health workers facilitate culturally competent service delivery. And they have been critical in reaching vulnerable communities during the pandemic. Another local workforce, pharmacists, are both trusted and accessible as well with 90% of Americans living within five miles of a pharmacist. Throughout the pandemic, they have been actively addressing vaccine hesitancy and ensuring equitable COVID-19 vaccine distribution and access. Our expert panelists will share how these trusted messengers, community health workers and pharmacists are essential to reaching vulnerable communities and addressing long-standing inequities.

Cait Ellis (00:01:22):

Before we hear from them, I want to thank NICHM's president and CEO Nancy Chockley and the NICHM team who helped to convene this event. You can find biographical information for all of our speakers on our website along with today's agenda and copies of their slides. We also invite you to live tweet during the webinar using the hashtag reaching communities. I am now pleased to introduce our first speakers Denise Octavia Smith. Denise is the founding executive director of the National Association of Community Health Workers. She is a leader in public health and actively works to amplify the roles of community health workers to strengthen and support the public health capacities. Denise is also a visiting scholar at the Harvard Medical School Center for Primary Care and Aspen Institute Healthy Communities Fellow and a Robert Wood Johnson Culture of Health Leader. We're so grateful she is with us today to share her expertise and perspective. Denise.

Denise Octavia Smith (00:02:16):

Thank you so much for having me. It's a great honor and pleasure to represent the National Association of Community Health Workers as we seek to build a movement for equity and social justice during the pandemic. The National Association of CHW's was founded in April 2019 after many years of organizing of CHW's [inaudible 00:02:41] community health representatives and allies from across the country. And we are expanding our membership, we are engaging influencers, sponsors and partners, enhancing the leadership capacity, educating our stakeholders on the evidence and the impact of our workforce and establishing a national and sustainable voice on issues related to the CHW workforce.

Denise Octavia Smith (00:03:07):

I want to just take a moment and thank my peers, my fellow CHW's for all of the work that they have done in this year plus of our pandemic. Community health worker's an umbrella term. And as I mentioned, it includes [inaudible 00:03:23], community health representatives and dozens of other job titles. CHW's are frontline public health workers who are trusted members or have a very close understanding and shared experience with the communities where they live and serve. It's these trusting relationships that allow us to bridge or liaison both a medical, behavioral health and social needs services and to really facilitate improved access, increased quality, cultural competence of service delivery.

Denise Octavia Smith (00:03:59):

CHW's are predominantly persons of color, predominately women who share ethnicity, diagnosis, socioeconomic status, geography with the communities where they live and serve. We are disproportionally affected by inequities, often experiencing many of the same barriers to the social drivers of well-being and healthcare with marginalized communities. And so as a result, we are unique stakeholders pursuing equity in health system transformation and representing often both provider and patient or consumer voices. As designated health professionals in the patient protection and Affordable Care Act, CHW's have proven effective in reducing health inequities, containing costs, improving outcomes across a wide range of diseases.

Denise Octavia Smith (00:04:54):

More than a year into the COVID-19 pandemic, tens of millions of Americans are still being victimized by COVID-19. Leaders continue to call for increased testing, contact tracing and the maintaining of public health measures. And pressure is mounting for racial equity in vaccine development and distribution. Now is the time identify CHW's as a trusted and skilled workforce with experience responding to infectious disease pandemics like HIV and natural disasters like hurricane Katrina to join this fight and to scale up Americas readiness for future pandemics.

Denise Octavia Smith (00:05:33):

Yet despite nearly 60 years of research on CHW effectiveness, two decades of public health recognition, landmark workforce development studies and a national labor classification, CHW's are still building a national professional identity. And federal and state policies and funding models have often failed to reach CHW's and our CHW led network, association and coalition.

Denise Octavia Smith (00:06:09):

On March 19, 2020, the US Department of Homeland Security demonstrated the urgency to engage CHW's in this pandemic when it issued guidance to states, tribes and territories that classified CHWs as essential critical infrastructure workers during COVID-19. However, in the early months of the pandemic, many CHWs working in health services and systems, local health departments and community-based organizations were laid off, told to go home at the very moment when we needed to strengthen our connectivity and communication with community. These and many other public and private employers of CHWs did not fully understand the ways in which our roles could really aid and strengthen public health response.

Denise Octavia Smith (00:07:03):

The slide before you is a broad range of CHW roles. I'm focusing currently on equitable vaccine infrastructure and distribution. But the earlier slides and most of the slides are hyperlinked so that you are able to read the blog and health affairs to look more carefully at some of the documents that have been endorsed by both global and US organizations in support of US CHW during the pandemic.

Denise Octavia Smith (00:07:34):

CHWs can co-design, develop, distribute and evaluate materials and strategies. Coordination and administer a variety of screenings around food insecurity, housing, financial needs, mental health services and help people directly navigate to those services and conduct meaningful follow up. We can navigate technology, literacy, language, enrollment and transportation barriers to ensure access to the vaccine, other emergency services. Help people to gain access to healthcare coverage, Medicaid, as well as private health insurance. We can coordinate mobile testing and vaccination sites as I did as a CHW helping to ordinate a mobile health van for HIV testing. We can organize tabling and registrations, collect data, monitor symptoms and engage the home bound, those who are houseless or those who are transient in our communities.

Denise Octavia Smith (00:08:44):

I just want to take a moment and say that the primary issue around equity in vaccines will remain an issue of access. We have had historic inequitable access by nature of the cost of care, rural areas where transportation is an issue, literacy or language barriers, bias in healthcare systems that create different access barriers. But I don't want to miss the opportunity to say that our systems must also address historic and systemic racism and that this creates and additional barrier of low trust or mistrust in healthcare delivery generally speaking. We don't promote using terms like vaccine hesitancy because that is sort of superficial in a sense to say that people are hesitant when they have real concerns about whether or not the vaccine is going to be efficacious for them, whether there's going to be side effects, whether they can still become still and infected with COVID. We have to address the real misinformation so that we can ensure we have effective vaccine distribution. And we also need to acknowledge in our health systems that we've had a history of unethical or harmful medical treatment among many different communities.

Denise Octavia Smith (00:10:19):

I want to take one more moment to continue my focus on equity and social justice and just step back for one moment. In April 2020, NACHW released a guide for CHWs, you see it here on the right side of your screen, in partnership with the Austin Asian Community Health Initiative and Khmer Health Advocates to help CHWs respond to the stigma and the violence experienced by our Asian American and Pacific Islander community members and to report AAPI hate. As I was preparing these slides, the stop AAPI hate website has documented over 3700 incidents from verbal and online harassment, physical assault and civil rights violations. And so, it's very important that employers or partners of CHWs recognize that there is a critical role for CHWs working deeply in community to address these issues, not only of inequity and access but also of community violence.

Denise Octavia Smith (00:11:25):

I want lift up here that NIHCM has been able to partner with many different organizations both global and US to amplify the critical roles of CHWs as bridge builders, as navigators to remove or traverse significant barriers, to bring cultural mediation and to really innovate and adapt services during this time. We're grateful to have these partners.

Denise Octavia Smith (00:11:53):

NACHW has also taken time to develop report from national polling's that we've done of our membership to help those who are employing CHWs have a better understanding of, during the pandemic, of the training needs, the self-care needs and the needs of the communities that CHWs are serving. We call this From Crisis to Opportunity. We have also partnered and we helped to co-found the Community Based Workforce Alliance, again with global and US partners so that we could help and guide local health departments and others to advance authentic CHW engagement in COVID-19 response. If you really want a tool to help you understand what recruitment looks like, what hiring looks like, what supervision looks like, what training looks like, what career pathways look like and how they can be built into this short-term pandemic response, we offer this tool to you to guide some of your work.

Denise Octavia Smith (00:13:05):

As I begin to close, I just want to say NACHW is a proud partner with Health Leads, The Native Ways Federation, [Spanish 00:13:12], Partners in Health, CHAP and many others in a comprehensive two-year US vaccine equity imitative. We found that we needed a collaborative approach to create a repository of vaccine messaging, toolkits, data and research to make it accessible to hyper local community-based organizations and CHW networks. They are still very much disconnected from some of the conversations that are happening in research, in academia, in government because we don't have a robust community-based infrastructure. And we want these organizations to have the very best evidence and tools to promote equity in vaccine distribution as well as to promote strategies. And innovation and capacity to address racial health disparities and spark a movement of equity while we're planning for this vaccine distribution across our country.

Denise Octavia Smith (00:14:13):

Finally, in February 2021, NACHW will release a national CHW policy platform. Many organizations have come to us and said they want to take this opportunity where they are scaling for vaccine distribution to address short term social needs during the pandemic, to scale testing and contact tracing. That they see this is an opportunity to rebuild the public health infrastructure and specifically to integrate CHWs. This platform provides evidence-based policy recommendations for public and private institutions to respect, protect and partner with our workforce. It was created over a year with town hall calls with over 30 CHW associations, three national polls, many different partner meetings and a lot of input regarding the Biden administrations national plan to build that better that came out last winter.

Denise Octavia Smith (00:15:14):

It centers a lot of the polices and best practices that are already nationally endorsed within our field. And it can be applied to COVID-19 response efforts now as well as long term sustainable policy development. We include things like ensuring that CHWs have access to PPE and a living wage while they're responding to the vaccine. Making sure that CHWs in every state have access to the vaccine while they're on the frontline. We promote hiring of authentic CHWs who have established trust and shared life experience with the communities where they live and serve. And we advance the approaches to directly invest in and partner with our CHW network associations and coalitions to ensure that the rebuild and recovery from COVID is equitable.

Denise Octavia Smith (00:16:06):

We invite legislatures, public and private institutions, funders and providers to meet this challenge and maximize opportunities to recognize, fund and sustain the indispensable work CHWs are doing now and have been doing for decades to secure a sustainable future for the workforce. Our work will continue to promote this essential critical infrastructure workforce to share insights from national polls and listening sessions to encourage investment and support of our network. And so, to ensure that if you are an employer you are implementing policies the promote self-care and develop approaches that really support your workforce’s well-being as well as for the communities they serve.

Denise Octavia Smith (00:16:54):

We want to thank all of our founding sponsors who have come alongside of the National Association to help us build this equity movement and to amplify the professional identity and leadership of our very diverse workforce across the country. Thank you so much for your time today.

Cait Ellis (00:17:15):

Thank you so much Denise for sharing your work and providing us with a greater understanding of the role of community health workers, how they are unique stakeholders in this space and their ability to really promote equity during the pandemic and going forward.

Cait Ellis (00:17:31):

Under the leadership of president and CEO Craig Samitt, Blue Cross Blue Shield of Minnesota has a been a recognized leader and partner in advancing health in communities across the state and advancing health equity. Today we will hear from Chris Reiten, vice president of Medicaid and Dr. Amy Fendrich, senior medical director. They will share their efforts to strengthen and extend the community health worker infrastructure in Minnesota communities as well as how their work helps reduce health disparities and bridge cultural and language barriers. We are so fortunate that they can be with us today to add their perspectives and expertise to this conversation. Dr. Fendrich, I'll start by turning it over to you.

Amy Fendrich (00:18:12):

Thank you so much. I want to start by thanking Denise for that excellent presentation on CHWs and putting the perspective that's needed for CHWs. I want to thank NICHM for inviting Blue Cross Blue Shield of Minnesota to share our health plan experience with CHWS. I just want to clarify that we're an independent licensed [inaudible 00:18:39] of the Blue Cross and Blue Shield Association so when Chris or I speak of Blue Cross, we're specifically referring to Blue Cross and Blue Shield of Minnesota.

Amy Fendrich (00:18:54):

In this slide, we're looking specifically at health disparities in Minnesota with data from 2019 that was published in 2020. What's interesting is you can see at the top of the slide, Minnesota has historically been ranked as one of the healthiest states in the nation. However, when you dig into the data that's presented on the left side of this slide, Minnesota ranks as one of the worst states with respect to health disparities. As you can see, Native Americans and black experience homelessness that's 17 times that of the white population. Blacks experience disparities in nearly all of the health indicators. Minnesota was 43rd in the incidence of adults with mental illness that report unmet needs.

Amy Fendrich (00:19:47):

When you look at the right side of the slide and you see the health impacts, you see 65% of Minnesotans are obese or overweight. $5 billions the estimated human and economic costs associated with alcohol use in Minnesota which is 17 great than alcohol tax revenue. 17% of Minnesota women consumed at least half a serving of alcohol during their last pregnancy. There are tremendous health disparities where in a state that is recognized as being healthy.

Amy Fendrich (00:20:31):

In the next slide here we look at what happened with COVID-19. As Denise noted, we see what occurred in populations during the COVID pandemic. COVID illuminated health disparities in our state, in our nation and in the world. In Minnesota, blacks represent 7% of the state population but 9% of the documented COVID cases and 12% of hospitalizations and ICU admission. I would guess that 9% is an under estimate by a fairly sizeable of COVID cases. Native Hawaiian and Pacific Islander residents test positive at twice the rate of white residents of Minnesota. Speak about a call to arms.

Amy Fendrich (00:21:30):

In our next slide, COVID and the disparity that was laid so plain created and urgent need to evaluate how we could reach all members in all communities. We needed to act quickly and needed to figure out how to reach members, telephonically. In CHWs we benefit from, as Denise mentioned, the trust factors that CHWs bring. They often live or work, come from communities that they serve. They offer cultural understanding, language fluency for our members with limited English proficiency or those who do not speak English at all. Data supports that CHW programs have positive effects on health and quality of care. They address many of the social determinates of health in our communities which we know impacts the delivery of healthcare.

Amy Fendrich (00:22:26):

Blue Cross of Minnesota has a long history of work with CHWs. For quite some time, we've identified the challenge of the need to reach communities that are not receiving healthcare. Some of this is related to language barriers, some is related to lack of trust of the medical community and some is due to low health literacy. We partnered in the past with the Minnesota CHW Alliance to develop a certified curriculum. We worked with a community hub in Winona follows the pathways community hub model, coordinating and range of community resources of which healthcare deliver is just one part.

Amy Fendrich (00:23:07):

The site in Winona is currently working on certification as a pathways hub model. The pathways hub model includes whole person, whole family community care coordination, use of existing community resources more efficiently and effectively. Coordination of community level outreach, engagement and connections to social and clinical care, work with any population, measure and address local health risk factors and comprehensive risk assessment, assigning pathways and tracking and measuring results. In 2016 to '17, we had funded two community health workers positions in two Minnesota cities. We learned a lot from that previous work which included improved reimbursement, providing CHWs with appropriate support. In 2019, we helped to fund a CHW registry and created a scholarship fund to encourage growth of CHWs.

Amy Fendrich (00:24:10):

And here's what we learned from our previous work with CHWs. Sustainability depends on the coordination of infrastructure, historical partnership with the established CHW networks can increase deployment of new strategies. Collaboration and flexibility allows for continuous improvement. I'm going to go ahead and pass it over to Chris to discuss what else we have done in this space.

Chris Reiten (00:24:51):

Thank you Dr. Fendrich. Yes, this is Chris Reiten and I am excited to be here to highlight some of the additional work that we're doing in this space. So, I'm going to go a little bit deeper and talk about some of our current initiatives. Given the very positive experience in our previous work leveraging community health workers in providing education, reaching out to members and building trust with vulnerable populations, we began working on an initiative related to emergency department utilization in partnership with WellShare International and then COVID happened. We quickly had to pivot our work with WellShare and develop a different model together with the goal of bridging cultural and language barriers. We wanted to convey important information to members related to COVID-19. We wanted to connect with members in the community and connect them to member resources and close gaps and fear through education and through engagement.

Chris Reiten (00:25:58):

We felt certain that during the public health emergency that community health workers would have more success reaching our members. They know the community that they work in. They have established trust, they're local. We started this initiative in our pivot with identifying three metropolitan counties in Minnesota and selected Spanish, Hmong, Somali and [inaudible 00:26:24] speaking members for outreach efforts. And quickly developed resources guides for the community health workers to leverage in their outreach. And then we hit the ground running.

Chris Reiten (00:26:37):

At the same time, we wanted to ensure that we were creating sustainable models. We did an analysis of the community health worker rate structure and we wanted to ensure that the overall level of reimbursement was reflective and covered actual costs of all the work that we were asking the community health workers to do. We also focused on exploring how we could enhance the reach of community health workers throughout the state by exploring expansion of additional community hubs. And we started work on developing a full enterprise wide strategy in how we would use community health workers across different lines of business.

Chris Reiten (00:27:24):

But what we were seeing in the community? First, we knew that socioeconomic factors, physical environment and health behaviors all impact the access and quality of care which really made address social determinates of health more important that ever. We felt that this model was uniquely suited to make a difference. We learned in member conversations that members were afraid. They were afraid to seek in-person care. They were reluctant to seek resources to address their household needs. And they wanted more information related to COVID safety. What we observed through data was a dramatic decline in well child visits and immunizations. They were 20 to 30% lower in 2020 than what we had experienced in 2019.

Chris Reiten (00:28:23):

Initial results, well we were very pleased with the initial results. Our engagement rate was approximately 35%. More than 14000 members received outreach, that equates to about 3400 households. Due to the community health worker outreach phone calls, two to 7% of members closed identified gaps in care which was notable given the reluctance that were hearing to seek care during the public health emergency. We also saw positive results in claims data for pregnant women that WellShare had reached out to. The statistics are listed on this slide. 7.6% of pregnant women received timely prenatal appointments and postpartum visits. And an additional 4.7% of the members received their prenatal care, prenatal immunizations such as influenza.

Chris Reiten (00:29:26):

We continue to evolve our programing with WellShare with our Medicaid membership but we're thinking broader. We first started with COVID education to include gaps in care, immunization, education, again continue to expand the outreach based on what we're hearing in the community. What we heard recently, members want to know where they can get vaccinated. We're enchaining the outreach program to help members, direct members to where they can secure appointments for their families. Offering transportation when and if it's needed. We heard through members through outreach that they had difficulty accessing COVID related supplies. If you take a look at the picture on the right of the slide, we quickly put together COVID care kits. It includes adult and child size masks, hand sanitizers, bar soap and thermometers. We’re continuing that program to make sure that we're getting these resources out to members.

Chris Reiten (00:30:31):

We intend to continue to work on leveraging community health workers for ER education, ensuring that members and families have secured a primary care home to access their medical needs. We are continuing to partner for future community hubs outside of the metro area. And we're continuing to seek certification for Minnesota pathway hubs starting in Winona which is a rural community, a rural hub and also pursuing a hub in Minneapolis.

Chris Reiten (00:31:06):

But before we transition to the next speaker, I really would love very much to share a very quick member story. The complexity of trying to get medical care or any needed care is made even more challenging with language barriers, not understanding the specifics of healthcare and choosing providers and clinics. The member success story that we received from our partner WellShare was from a member that had no support system. They weren't able to speak or read English. She was 40-year-old woman with two small children and had recently had a stroke. She was still experiencing issues. She needed additional help. She needed additional support. A community health worker through WellShare helped her access additional services that were covered by her insurance that included acupuncture physical therapy to help relieve her pain. It also directed her to community resources to help with other needs. Helping her find a car seat for her child, food and clothes for her growing son.

Chris Reiten (00:32:12):

A second success story, and then I will wrap up, that we received from a community health worker was that we had a Hmong man in his 50s that hadn't been to a doctor for more than a year. Him and his wife had been feeling unwell and unsupported and had not been making trips to their physician or refilling his medication. He felt that he had no other option but to take his wife's medication. With the help of a community health worker, he was put in touch with the couple and was able to help the man reconnect to his preferred physician, get his medication refilled and direct him over to community resources. I will wrap up here and say thank you very much for having me today.

Cait Ellis (00:33:04):

Great, thank you so much Dr. Fendrich and Chris for sharing Blue Cross Blue Shield of Minnesota's leadership in the community and just how quickly and successfully you were able to pivot your programming and partnership to meet the needs early on in the pandemic.

Cait Ellis (00:33:18):

Our final presentation today will be from Rick Gates, senior vice president of pharmacy and healthcare at Walgreens. Rick is responsible for commercial development and sales, contracting, pharma development, pharmacy supply chain, clinical programs and alliances. He brings extensive experience to our panel and we are so pleased to have him with us today to share Walgreen's efforts to support the health and wellness of the community during the pandemic including how pharmacists and pharmacies can play a significant role in advancing health equities and reaching underserved communities. Rick.

Rick Gates (00:33:54):

Yes, thank you for inviting me to speak today. It's certainty great to be on with this great panel. As we talk about this, just want to start by saying what excites me about what's happening through the pandemic is the role that pharmacists really are playing in our health ecosystem is truly in full view. I think as you look at it beyond just testing and vaccines, really it's the trusted care, the local access and I think the importance of healthcare being local like we talk about all the time. As we get into it I will kind of walk you guys through where we are and then kind of expectations and then where I think we're going to go.

Rick Gates (00:34:34):

As you look here, it is a worldwide crisis but response to this is local. There will be testing in over 5000 locations, vaccinations which I think we're ramping up to our full chain as we move forward. Walgreens has about 90 to 100 brick and mortar locations. We have reached across many communities to really have impact. We have 59000 trusted pharmacy team members who have expertise for vaccinations to really help us as we work to pivot forward from the pandemic itself.

Rick Gates (00:35:05):

I think it's important though as you look at where we are and where we're going to kind of take a history lesson on why pharmacy's so well placed to really help through the pandemic, especially when you look at vaccinations. COVID-19 may be a new experience for us all but it's actually not new for our model and how we implement actual care at a local level. The H1N1 pandemic, if you look at back to that, was really what paved the way for pharmacist’s ability to administer vaccinations. It really was where states expansion and authority went from 17 states where pharmacists can vaccinate to 40 states. I think since that point you've seen us come a long way. In 2009, we had about 8000 pharmacists that were licensed to administer flu shots. Today were at about 59000 active vaccinator that we have and it continues to grow as technicians have gained authority to administer vaccines in certain states under supervision of a pharmacist as well.

Rick Gates (00:36:05):

I think the power of that is that our pharmacy team members not only work but they live in the communities that they serve so they're embedded there. And they have experience with different immunization models to ensure every single eligible adult, including people in rural and underserved areas have access to vaccinations. And so, to that point, we've posted up to this point, already hundreds of community clinics outside of our stores and we're planning to significantly ramp that up as vaccine becomes available.

Rick Gates (00:36:32):

I think as you look at pharmacy in general, I think Walgreens as the example here, our pharmacists experience an extensive vaccination training along with a network of manufacturers and distributor relationships nationwide footprint, it really provides the strong foundation for which we've been able to accelerate the delivery of COVID vaccinations.

Rick Gates (00:36:56):

I think I'm just going to take you through kind of what we've done to really step up and continue to evolve and expand our offerings to support the communities that we're in based off what our patients and consumers are needing. I'll just walk you through some examples here because it goes beyond obviously just dispense of medication and advice. But really, we've done some things that have been unique that I think we'll learn from to really improve the care that we're offering through our platform as you go forward in our communities.

Rick Gates (00:37:25):

First was proactive patient outreach to high risk patients. We identified when shelter in place was occurring that some patients may have challenges getting or be fearful of leaving their house to get medications. So, we did outreaches to those with multiple chronic disease conditions to ensure they had medication. Offered delivery if necessary to make sure they had their medications.

Rick Gates (00:37:47):

We trained pharmacists for outreach and chat to provide individualized support and solutions to really make sure that people knew how we could help keep them safe. We rolled out contactable COVID-19 testing to provide that service to consumers across the country really at the request of the government to expand testing in more communities. And now we have over 5000 locations where we are offering COVID contactless testing as well. We've done a lot to expand deliver and/or solutions to make it easier to get products and not just having to come into our store. So last mile delivery through Postmates, Door Dash, offering our full store assortment through our drive-through and we've launched curbside pickup as well. So just trying to create solutions that consumers are looking for in not only a pandemic but also solutions they'll be looking for post-pandemic as well.

Rick Gates (00:38:40):

Last but not least is really looking at telehealth which obviously has been expanded quite rapidly through pandemic. But we have a Find Care platform where we have been working with local health entities, health systems and others to bring relevant solutions to consumers. But we've seen nearly 20 million visits through that platform to really help connect patients to care be it mental health or just acute based care that they may be looking for through telehealth services. And I think it all just really goes back to supporting our purpose for championing the health and well-being of every community in America that we serve.

Rick Gates (00:39:16):

Just really quick I'll talk a little bit more about our people which I think is probably the most important part of what we have in the local nature of our platform. And then I'll talk about the pandemic a little bit more specifically and our support. But I would say that what I'm most proud of is our Walgreens team members and how they've really stepped up to support throughout the pandemic. Our pharmacy team members had been on the ground since the beginning to really support testing in the early days and obviously the vaccinations that are happening now. Patients have relied on us more than ever before not only to provide access to medications but also trusted health resources.

Rick Gates (00:39:54):

I think you've probably heard this data or if you haven't I think it's important to note that pharmacists were already one of the most frequently visited healthcare professionals leading into the pandemic. I think these frequent touchpoints with patients have helped us do things like improve medication adherence, obviously ensure that they understand safe medication use. But I think we've expanded those with offerings. It's how we can be a more trusted health resource during the pandemic and I'll give you a couple examples of that just to really better support throughout the pandemic.

Rick Gates (00:40:28):

One example is our health outcomes pharmacists were trained in mental health literacy to really understand risk factors and warning signs for mental health, in additions concerns as well as give them strategies for how to help someone in both crisis and non-crisis situations. Obviously shelter in place and having such rapid changes for people's lives I think meant the mental health would be something we want to support much more effectively going forward.

Rick Gates (00:40:55):

Second, we really helped patients navigate the complexities of healthcare system by assisting them find coverage if they had a lapse in their healthcare coverage. A lot of joblessness, a lot of changes in employment be it furlough or loss of jobs, we really built up solutions to help them understand and how can I understand how to enroll in Medicaid, understand health exchanges, look for lower cost alternatives. And that's a big part of what we really try to do is say it's important not to stop taking your medication but we can try to help you find a lower cost alternative, that's what is important is for you to stay on medication as well. I think through the pandemic we're ensuring that our entire pharmacy team has had the support and resources to continue to provide care to their patients as well as evolve our solutions really to help.

Rick Gates (00:41:47):

Next, I'll just pivot into what's been happening with vaccinations. I think a lot of what you've seen started with long-term care facilities. We were certainly proud to assist the administration as one of the first pharmacies to administer COVID vaccines back in December. It was an incredible opportunity for us to obviously help vaccinate the nation’s most vulnerable. And I think to date we've completed nearly 70,000 long-term care facility clinics and really tried to bend the curve if you will on not only case spread but mortality rates that were seen in that highly vulnerable population. And so happy to say that by and large those efforts are complete and we've been able to certainly vaccinate upwards of three million individuals in long-term care facilities as well.

Rick Gates (00:42:41):

But obviously that's expanded beyond that. What you've seen lately is movement into the federal retail pharmacy programs. As the Biden administration has come into office, they've set some pretty ambitious vaccination goal. Obviously, we're proud to part of a national effort to support this. I think what's important, and this is something I always want to make sure everybody understands is remember that the CDC, states and local jurisdictions are the ones responsible for prioritization of who gets the vaccine, allocation of the vaccine as well as keeping track of vaccine inventory. Which as we all know is still limited at this time but continues to grow.

Rick Gates (00:43:23):

Walgreens, and our role has been to provide vaccinations in about 5000 stores at this point across 53 different states and jurisdictions. Happy to say that we're increasing that every week as allocation does become more available. Allocation allotments are coming from the CDC and we continue to increase doses that we're putting in stores to serve medically underserved areas and areas with high social vulnerability index scores. We're seeing allocation quantity increase every week and are confident that we can meet the expectations of both the administration and the community. I think that we're all wanting to know when it's going to be even more available but I can tell you that vaccine quantities are increasing on a pretty consistent basis.

Rick Gates (00:44:08):

But I think it goes back to really making sure that we're focusing on vaccine equity. I know the other two presentations really focused on this quite a bit. Of the allocation that Walgreens does get we are putting nearly half of it in stores in medically underserved areas and high social vulnerability index scores like I mentioned before. When we put them in these stores we actually have our pharmacists making proactive outbound calls to ensure that residents that are served by those stores and in those communities receive vaccination appointments to get vaccinated. But that's quite honestly just part of the plan that we have of our large vaccine equity efforts.

Rick Gates (00:44:50):

I might just take a moment and talk through some of the advanced key priorities that we have that are really part of our vaccine equity initiative bucketed into three things that you can see there on the side. One is creating new access solutions. The second being facilitating educational programs to address hesitancy and then third being fostering partnerships that best meet the needs of each community. I'll give a couple of examples in each of these just to kind of help paint the picture for what we're doing really to partner to really drive improvement equity across all the communities that we're in.

Rick Gates (00:45:26):

First is access. I talked about obviously putting vaccine in stores in medically underserved areas but we're also committing to clinics in more than 100 underserved communities across the country. I think we had some examples here recently about us partnering across Chicago, Atlanta and New York. You'll hear some in the upcoming days in Houston, El Paso and other cities as well. We're really working closely with state and local officials to really identify areas of need and where we can really work with local partners to really create the right type of environment to drive improvement in vaccination rates. Part of that is really working in communities with churches, advocacy organizations and creating partnerships to really address access to care as well.

Rick Gates (00:46:11):

Second is education. It's not just providing education and information to build trust from our pharmacists but we're also finding partnerships to really help there. An example there is Walgreens has joined the AD Council and COVID collaborative It's Up To You campaign really in an effort to raise awareness but really to build confidence in vaccines and increase vaccine uptake particularly in black and Latin populations as well.

Rick Gates (00:46:37):

The third one is talking through partnerships and partnerships to really improve access is how we look at that. Walgreens has joined forces to really address three major barriers to vaccine in socially vulnerable communities. We look at its transportation, it's trust in technology. Transportation, we've had the announcement of our partnership with Uber. Really looking to say how can we offer free rides to individuals with transportation challenges to receive vaccinations. We've been watching those in all of the clinics that we talked about in medically underserved areas in Chicago, Atlanta, Houston, El Paso, the examples I gave before. But really just trying to say if consumers have issues getting to a pharmacy and/or getting to a clinic site, how do we actually bring down those barriers and really help them get vaccinated?

Rick Gates (00:47:33):

The second is the trust barrier and that's really working on educational programs. A great example there is in Chicago where we're working closely with the Chicago Urban League and other community leaders to really build the right type of education information and really working in the community to build that trust and answer questions to get people in to get vaccinations. And last but not least is the technology barrier and that's really working with partners to really develop technology to make it easier to connect people with vaccine appointments and information. And really, quite honestly, just to help them understand the positive impact of getting a vaccine as well.

Rick Gates (00:48:15):

As we get close to wrapping up here, I just wanted to highlight this is our shot. This is an ad campaign that you'll see us come out with. Working with John Legend is one of our speakers with it. But we share the enthusiasm with the nation in getting as many people vaccinated as quickly and as safely as possible. I know the administration has announced April 19th as trying to move the nation to max availability. Some states have moved quite honestly a little bit in advance of that but it's a moment that Walgreens and our leaders and our teams have been waiting for and we're ready and proud to accelerate vaccinations to really support the country across our entire platform obviously in all areas that we can obviously get too to support.

Rick Gates (00:48:58):

We look at is, this is our shot to serve the communities that we're in. This is our shot to showcase our trusted expertise and this is really our shot live our commitments to safety and equitable distribution of healthcare. We do believe it's not just Walgreens but together everyone working together to help emerge from this pandemic. In closing I'll just say that it's been an unprecedented effort I think by everybody. I think even as Walgreens we're continuously learning and improving. I can tell you that there's lots of learners we've had. We've not been perfect across what we're doing but I think that agility and working through partnership to really bring solutions to market is what I've been most proud of as an organizations goal. COVID-19 has been an incredible case study on how pharmacists can play a critical role in healthcare puzzle by providing not only compassion, information but care for people of all ages across the communities.

Rick Gates (00:49:57):

Quite honestly, I'll just say that I'm proud of what we're doing but I'm really excited I think. I have my mother whose gotten her vaccinations and now two weeks post vaccine and I'm going to be able to really go sit down and visit with her in a week and a half with kids in the next couple weeks. I think that there's just so many stories of how vaccines and how working together can help us pivot into hopefully a post pandemic world. With that I'll transition back.

Cait Ellis (00:50:27):

Great. Thank you so much Rick for providing us with all of that valuable information on the role of pharmacists during the pandemic, their local role as embedded and trusted community members and how their expertise can continue to be leveraged going forward.

Cait Ellis (00:50:42):

We'd like to use the remaining time to engage in a Q&A session with our audience. Please continue to submit your questions in the Q&A tab. I'll start by asking all of our panelists to come off of mute. We have had a few questions come in around accessing funding for community health workers or connecting or partnering with community health workers. This is really for Denise, Chris or Dr. Fendrich but how can an individual connect with or identify community health workers at the local level? And if you could share more resources on how to access funding to either hire or support a community health worker. I know there's been some federal funding that's going to local health departments so how can local health departments utilize that funding to build out the infrastructure but then other organizations as well? So, turn it over to whoever would like to get us started on that question.

Denise Octavia Smith (00:51:39):

Sure, this is Denise. I'll just say a couple of things and pass it on to my colleagues. First is that if your sort of anywhere in the US and you're just sort of wondering where community health workers are? While some of us work in local health departments, hospitals, health plans, providers offices, the majority of us are still working through community-based organizations and non-profits. One of the best ways for you to find where [inaudible 00:52:09] CHWs are is to identify the state-wide, sometimes it's a county-wide or sometimes it's even a city-wide CHW network or association. In large states like Texas, there is a Houston CHW Association, right? Whereas for my state of Connecticut, we have one for the entire state. There are many places where CHWs working in many different sectors are already coming together for training, for mentoring, for advocacy. If you're looking to recruit, to hire CHWs, to train, to get training or to partner, that's really the best place to go.

Denise Octavia Smith (00:52:47):

If that's not helpful, if you go to the NACHW website and you click on membership, we have a listing of training sites across the country and CHW networks and associations across the country and that can sort of help you. Or you can always reach out to us. There is a number of different RSPs that have been released, most prominently two from the Centers for Disease Control, the Office of Minority Health has one that's out focused on health literacy. Others certainly will be coming. We're excited about the opportunity. As I mentioned, non-profits and community-based organizations cannot apply for that funding so that's going to come through your states health department. And so, if you're an advocate, if you're a champion of the CHW model, if you want to see that model scaled in your state, then it really behooves you to reach out to your department of health, your DPH and really ensure that there is equity in the distribution of those funds. That those funds go to organizations who authentically hire CHWs who recognize the cultural diversity of your communities and respond to those community needs.

Denise Octavia Smith (00:54:01):

As I mentioned, local health departments are doing some really innovative work across the country. Here in my state of Connecticut, some health departments are hiring CHWs locally and into the operations budgets. Others are partnering with CBOs through grant funding.

Cait Ellis (00:54:23):

Great, thank you so much. Just an extension of that question, we then can extend to Chris and Dr. Fendrich, we had a few people ask specifically if there are any lessons learned or advice that you would offer to other health plans that are interested in partnering with community health workers?

Chris Reiten (00:54:44):

Yeah, absolutely.

Amy Fendrich (00:54:46):

I'm going to [crosstalk 00:54:47] that over to Chris. Yeah, okay, go ahead.

Chris Reiten (00:54:47):

Oh, okay. Yeah, absolutely. Lot of lessons learned. I'm going to start first with as made the decision on how we move forward with some of the initiatives we did a lot of research. We invested in the community, we engaged with the community. We asked our local [inaudible 00:55:00] QHCs. We partnered with Hmong partnership and other community agencies to talk about where do we start, how is this going to work? Some of the lessons learned was really collaborating with an established CHW organization was really beneficial. When we started our partnership, we had an initiative in mind and we had to pivot very quickly. Another lesson was we gained a lot of agility with the CHW model in response to periods of crisis. We went from this initiative to let’s focus on ER to let’s do some additional education.

Chris Reiten (00:55:43):

Another lesson was telephonic community health worker visits proved to be really effective. We were in a new world, a new state where we had community health workers feet on the street, boots on the ground working with our members and now there was a fear of in-person care. We were trying, like everybody, the first-time telephonic visits and they proved to be very effective. We also learned that reimbursement must be sufficient to support the work which is what I mentioned as part of my presentation. We started with an analysis to make sure that what we were going to do was going to be sustainable. Another lesson was supporting organizations engaged in developing the CHW system. And infrastructure really has statewide benefits. So, here's where we started but here's where we're going to go. It's kind of evolving even as we speak in terms of how we leverage what we've learned and move it into different areas of the state.

Cait Ellis (00:56:51):

Great, thank you so much.

Amy Fendrich (00:56:52):

I'd also like to just comment on an addition. I think historically healthcare provider have often been so focused on patients that are difficult to get into healthcare and why don't patients follow up? I think it's just really important, if we have lessons learned from COVID, this would be it that we need to be out in communities that have difficulty with access and any number of issues in accessing healthcare. This might be the missing link for getting patients to receive the healthcare that they need.

Cait Ellis (00:57:47):

Great, thank you so much. I think we have time for one more question that I'd like to open up to all of our panelists. And really it's more if there's any closing thought or statement that you'd like to leave our audience with, what is one lesson or practice that you would like to take from this pandemic experience and to see continue or even scale up going forward? What has been your biggest learning experience that you think will inform more future work and that you hope the audience can take away that bit of knowledge with them as well? I will ask you jump in.

Chris Reiten (00:58:28):

This is Chris Reiten and I will just start. And this is really pretty simple but I think one of the lessons learned is everybody was obviously surprised by COVID-19. I'm speaking for myself. We very quickly had to pivot to try on different strategies that were going to continue to allow us to reach our members to get them the care that they needed. And so continually thinking proactively about how we can be agile in addressing the needs of our members through different models to remain responsive to meeting their needs in periods of crisis.

Rick Gates (00:59:10):

Yeah, this is Rick and I would just word is as I think for us, ability to partner and agility is something that not only I think is going to be a benefit but I think it's the way that we have to work going forward. You need to find expertise in the marketplace to partner with to really accelerate solutions going forward. I don't think we know what the future state consumer demands are going to be. We don't know what the new normal’s going to be. We always just talk about it so I think we just have to make sure that we're agile and still working towards that.

Denise Octavia Smith (00:59:42):

And I would just add that we are reconciling with the fact that we need not only a medical response, not only a public health response but we need a deep and significant community response to this pandemic and to rebuild and prepare for future pandemics. Our Blue Cross partners talk to us about how they were innovative. The Walgreens teams talked about how they were expanding the scope of work, the expertise, the services to address community needs. And the majority of community health workers are existing right now serving and with shared experience of the community. So I think as we think about an infrastructure that is going to exist beyond this pandemic to address the future pandemics and also to address the deep inequities and social needs that have existed for many, many decades, I think we need to come together and rebuild this infrastructure with the community as the center.

Cait Ellis (01:00:50):

Great, thank you all so much. Just want to thank our excellent panel of speakers for being with us today. And to our audience for joining us for this important discussion. Your feedback is important so please take a moment to complete a brief survey which can be found at the bottom of your screen. We do have other resources available on our website included archived videos from the first two webinars in this series as well as two new infographics on the role of community health workers and pharmacists in public health. Thank you all so much for joining us today.