Duong: Improving health while reducing costs in a federal funding desert

Community health in Santa Clara County is facing its gravest challenge since the depths of the COVID pandemic.

The full scale of the devastating cuts in federal health care spending contained in H.R. 1 will be felt this year in Santa Clara County and throughout the nation, and for several years after. That is why it is critical that we take rapid and concrete steps to improve the health of our residents and prevent future emergency room visits as much as possible, and we need our private sector healthcare partners to tangibly step up and join us.

In late April, the Board of Supervisors was presented with a program to improve the health of some of our most vulnerable residents that already proved its effectiveness during the pandemic: the Promotores and Community Health Worker Program. Promotores and community health workers are frontline public health professionals who share the culture, language and lived experience of the communities they serve.

During the first year of the pandemic, through the Community Health & Business Engagement Team, 200 promotores knocked on 180,000 doors on the Eastside and in South County. They had more than 120,000 conversations with individuals and visited 40,000 businesses to deliver crucial information about the importance of COVID testing and vaccines in historically and economically marginalized communities that were resistant to traditional outreach methods, or bypassed by those methods. The promotores got through to those communities because they were from those communities and spoke their languages.

Implementing a full-scale promotores and community health worker program will bring improved health outcomes to residents in every part of the county. The report presented concluded that every dollar spent on promotores or community health workers delivers approximately $2.50 in savings through avoided healthcare costs. This means less hospital visits and fewer crowded emergency rooms throughout Santa Clara County.

A significant part of the work that promotores and community health workers do is billable to Medi-Cal. This is where our private sector healthcare partners need to step up.

Both Anthem and Kaiser Permanente serve Medi-Cal eligible patients. If they were to contribute to funding a full-scale promotores and community health worker program in Santa Clara County, it would allow them to bill Medi-Cal for the eligible services and avoid the higher costs of emergency room visits and hospitalizations for untreated illnesses and conditions. They should make an investment proportionate to the total number of Medi-Cal members they have.

In addition to the long-term community health benefits, a full scale promotores and community health worker program can also be an engine of economic mobility. It can build a career pipeline allowing growth from promotora, or peer support worker, to certified community health worker or in-home support services worker by investing in training with stipends, paid experiential learning through certified apprenticeship programs and worker-owned cooperatives. This pipeline would build a more stable workforce and provide more economic security for the promotores and their children and families.

As we grapple with a federal funding desert in a post-H.R. 1 world, it is more important than ever that we avoid the most expensive healthcare options, namely emergency room visits and hospital stays, as much as possible. The promotores and community health worker program had its trial by fire during COVID and has proven its effectiveness.

It is as important, if not more so, that our private sector healthcare providers — in this case Anthem and Kaiser Permanente — partner with us and provide the funding necessary for a full scale promotores and community health worker program. It will be good for their bottom line, and deliver on their promise to improve the health and wellness of our shared communities.

Betty Duong represents District 2 on the Santa Clara County Board of Supervisors. She is a proud daughter of immigrants and a former beneficiary of county services, and the first Vietnamese American and first Asian American woman to serve on the county board.