State To Pay, Certify Promotoras
A new law aimed at paying community health workers will kick in this summer. These women and men provide health and social services to their neighbors and act as a vital link between time-strapped doctors and their patients. Health promoters – or promotoras – are helping homebound New Mexicans get the healthcare they need.
On a recent spring day Beronice Archuleta made the sign of the cross as she drove north from Tierra Amarilla, past a Catholic shrine in Los Ojos, on her way to visit a patient in Chama. Faith in healers runs deep in northern New Mexico’s mountain villages.
“I can’t even remember how long I’ve been a promotora," Beronice declared. "What was important to me, and still is, was being able to go into people’s homes and talk to them.”
Beronice is a community health worker who provides wellness checks for La Clinica del Pueblo de Rio Arriba. She co-founded La Clinica with her parents and neighbors in 1969 and has been helping to meet the health needs of her community ever since.
Making the trek to the nearest hospital in Espanola takes more than an hour by car, so Beronice’s healthcare home visits save patients energy, time and money. She also gives advice on how to get other kinds of help.
“If I go into homes and I feel that they need some kind of assistance, for example like the energy assistance or being able to buy food, you know, I make referrals," she said. Beronice added that she lets folks know there are places they can go and apply for assistance.
Promotoras provide a variety of preventive care services in a culturally competent way, from prenatal care and diabetes screening to guidance on diet, exercise, and glucose testing. In 2012 diabetes was the sixth leading cause of death in New Mexico. Its effects can be debilitating.
“I’ve seen diabetes where people before weren’t taking care of themselves or probably didn’t even know that they were dealing with diabetes and they’ve had amputations," Beronice said, "and that’s horrible.”
On a recent morning Beronice’s smiling face brightened the life of an elderly homebound redhead named Bonnie Jo Skinner. Bonnie Jo, who is 77, has lived with Type 2 diabetes for many years. She invited Beronice to sit on her blue cordury sofa and watched as the promotora took her glucose monitor and blood pressure kit out of her supply bag and promptly got to work checking Bonnie Jo's blood sugar levels and blood pressure.
It’s not just the patient’s vitals Beronice routinely checks - cheerleading comes with the job, too.
“You’re doing good, very good," Beronice announced. "There’s a big difference from the first time I came in, to now, a big difference.”
“They have that rapport with the client that’s just so strong,” said B.J. Ciesielski, founder of the New Mexico Community Health Worker Association. Ciesielski said promotoras play a key role in assisting doctors and their patients. “They can communicate with them at their own level, they really know and live the way the client does. They really fully understand, and I think that because of that, they really do trust them a lot, as much as they would a doctor.”
According to the New Mexico Department of Health, there are between 800 and 900 community health workers like Beronice in New Mexico. That number is expected to grow because of Medicaid expansion and mandatory health insurance requirements under Obamacare. Most of them have been working as volunteers or through short-term grants.
Beginning in July, the new law will enable the state to certify promotoras so they can be paid for their services through Medicaid. That’s what Beronice’s employer will do. The cost-savings will enable La Clinica to reinvest and buy new equipment.
For Cieslielski and the Community Health Worker Association, one of the best parts of the new law will be online access to resources.
“They’ll be able to create a webpage that will show what trainings are available," Cieslielski said, and she praised the development of a registry of community health workers that will display exactly how many are working in the state.
New Mexico’s Department of Health said a $500,000 budget will pay for the training needed for certification under the new law, and that the increase in community health workers will help address the health care worker shortage that exists for a third of the state’s population.
A pilot program to test the efficacy of Medicaid payments for promotoras nine years ago showed significant cost-savings. The results were documented in a 2011 UNM study that found patients who worked with community health care workers went to the emergency room less often and were admitted to the hospital less frequently than a control group. Researchers said that saved the healthcare system $2 million and, that once a promotora stepped in, people with diseases like diabetes started to manage their own conditions more effectively.
Bonnie Jo Skinner said she has used Beronice’s advice on diet, exercise, and testing to control her diabetes.
“I did my blood sugar in front of her so she knows I’m doing it right,” Bonnie Jo smiled.
On the drive back to the clinic, Beronice spotted a nesting falcon atop a telephone pole that she often sees when while visiting patients along the state’s rural highways. She took a moment to reflect on whether she's made a difference in people's lives.
"I think I have, and I enjoy what I do," she said. But as to when she may retire? "When they tell me ‘you’re to leave,’ or I can no longer move!” At age 68, Beronice said she looks forward to receiving her certification, and continuing on the road to better health for her northern New Mexico community.