Dr. Shreya Kangovi, a primary care doctor, civic leader, and founding Executive Director of the Penn Center for Community Health Workers (CHWs), is the 2019 winner of the annual Health Equity Award presented by the National Civic League in conjunction with the Robert Wood Johnson Foundation. Dr. Kangovi is an exceptional leader who has pushed the boundaries of thinking about what is possible in health care through community engagement.
A decade ago, Dr. Kangovi was working as a primary care doctor in West Philadelphia, where it is impossible to escape the reality that health care is broken, especially for the most vulnerable. In the 21st century, in the most developed country in the world, Dr. Kangovi saw her patients succumb to treatable conditions like diabetes by the time they were in their 40s. Dr. Kangovi saw that the root causes of her patients’ poor health were not just medical, but socioeconomic: issues like lack of housing, loneliness, trauma or hunger. These conditions were, of course, hard to “treat” in a clinic or hospital.
She wanted to improve the health of the people she served in Philadelphia and others in similar communities; she knew that this would require a fundamental innovation in how healthcare was delivered. At that point, she had some ideas, but was humble enough to realize that she had much to learn. She was also struck by the fact that low-income community residents were seldom involved in the design of health delivery innovations.
So she set out talk to the experts: community members themselves. Dr. Kangovi and her team had one-on-one conversations with 1,500 residents of high-poverty neighborhoods in West and Southwest Philadelphia. They met with people on porches, hospital bedsides and at shelters. They asked patients: “What makes it hard for you to stay healthy and what should we be doing to help?” Patients shared their experiences with health care, their barriers to health, and their vision of a holistic approach to caring for people. In addition to these interviews, Dr. Kangovi also made a point to interview civic leaders.
Dr. Kangovi used the stories, input and guidance from her community interviews to design, administer and execute a transformative new care model called IMPaCT. In the decade since Dr. Kangovi first went on her “listening tour”, IMPaCT has become a nationally recognized healthcare innovation that has transformed the lives of almost 10,000 Philadelphians and disenfranchised Americans across the country.
IMPaCT is a standardized, scalable community health worker program. Community health workers are trusted laypeople who help their communities to achieve health and well-being. Community health workers are not new, but prior programs have struggled due to turnover, lack of standardization and insufficient evaluation. Dr. Kangovi's model addresses those factors through specialized hiring tools designed to identify community members who are natural helpers; standardized workflow manuals, supervision, management software and training that ensure a structured, supportive work environment; and rigorous scientific evidence.
IMPaCT targets a broad population: residents of high-poverty neighborhoods who are uninsured or publicly ensured. Community health workers meet eligible individuals when they come in to the hospital or doctor’s office. IMPaCT community health workers get to know patients as people, including asking them about any unmet social need including but not limited to income, employment, transportation or housing. Community health workers ask patients: “What do you think you need in order to improve your health?” Based on this initial interview, the community health workers help patients develop action plans for improving their lives and health. A hallmark of IMPaCT is that these action plans are tailored to each individual and all of his or her lived experience. Community health workers then provide flexible, hands-on support to help patients carry out their action plans. This can take the form of navigation, connection to social services and health coaching but it can also be more creative and grass-roots.
For instance, one community health worker helped a young man --who had been paralyzed in a violent crime—to obtain a ramp for his home and sign up for a wheelchair basketball league. Another community health worker helped a woman –who had low self-esteem due to an abusive mother—to create and lead a support group for other young women. This approach to shift our culture to one of holistic health, incorporating all aspects of a person’s life, has concrete and measurable advantages. Simply put, the model works better then programs that attack individual social determinants of health like food insecurity and transportation as one-offs. It also has some benefits compared with the many technology-based ‘screen-and-refer’ solutions that have now proliferated in this space. Poverty creates complex layers of problems in unique fingerprints. Solve one, others linger. The holistic person-centered approach that IMPaCT has taken to the social determinants of health is probably a key factor behind its effectiveness.
Dr. Kangovi is a visionary thinker with bold goals. Her goal for the IMPaCT program is to eliminate health disparities –as measured by metrics like chronic disease control, hospitalizations and mental health-- by deploying effective, scalable community health worker programs. IMPaCT has measurably reduced health disparities in the greater Philadelphia region and is now the most widely disseminated community health worker program in the country.
To learn more about Dr. Kangovi and IMPaCT, visit https://chw.upenn.edu/about/
The RWJF-National Civic League Award recognizes individuals who have successfully implemented a systems change approach within the past two years to improve health outcomes for those most impacted by health disparities. Winners of the award address the factors that lead to health disparities related to one or more of the following areas: access to quality care, education, employment, income, community environment, housing, and public safety and demonstrate a commitment to resident/civic engagement.
The National Civic League views engagement as more than presenting information or having people respond to questionnaires (though both are important); instead, we promote efforts that seek to listen to, and learn from, residents in ongoing conversations and leverage those insights to shape the way programs are administered, designed and executed.