Addressing Health Inequity and Improving Patient Engagement Through CHW Training and Local Connectedness

Community pharmacy owners Mike and Chris Schweitzer of Bedford Drug in Bedford, Iowa are leading the way to address Social Determinants of Health (SDoH) in their local community.

All across the country the impact Community Healthcare Workers (CHWs) in the community pharmacy practice setting has been significant. Their effectiveness includes improving health outcomes, reducing healthcare costs, and bridging the gap in health disparities. CHWs are critical to improving individual and community health through their ability to build trust and relationships and advocate for the most vulnerable patients. As one of the most accessible healthcare destinations, community pharmacies with CHWs are uniquely qualified to address Social Determinants of Health (SDoH).

Bedford Drug has been serving the rural community of Bedford, Iowa for 57 years. Established by his father in 1965, Mike transitioned to pharmacy owner in 1999. Mike, the pharmacist, and Chris, the trained CHW, have deep roots in their community and strong relationships with patients and providers. Chris explains the demand for health equity and access to care continues to grow, “When the State pulled local Medicaid field offices out of our community, the level of care for this population has suffered.”

To illustrate the impact of their CHW actively participating in their pharmacy’s patient care initiatives, Mike shared a recent eye-opening example. A patient came into the pharmacy with the intention of paying the

$30 he owed from the previous month. When the patient swiped his debit card, the transaction declined due to lack of funds. “The patient became very agitated,” Mike shared. “He was out of money in the middle of the month and had no way to pay his bills. He was defeated, very defeated.”

Mike and Chris jumped into action. Chris worked with the patient by asking the right SDoH questions to gain details of his situation. The patient said that he qualified for disability coverage but he only received

$1200 a month to live off of. They knew he had a Medicare Part D plan due to his disability classification, yet he was not on Medicaid and was paying the full amount for his insurance premiums and copayments. He explained he won his disability suit without using an attorney because he couldn’t afford to hire one. In the end, he felt he didn’t understand all of the details of his award. They also learned he was struggling to pay a large amount of recent hospital bills and his access and level of care depended on paying off the accounts. He was using a local agency to obtain food through a food bank and possibly rent assistance to barely make ends meet.

Proving even further the value using a community pharmacy provides, Mike recalled seeing a military tattoo on the patient’s arm during a previous vaccination appointment. Mike asked if he was a veteran and the answer was yes. The patient served in the military for 16 years with three honorable discharges. However, he wasn’t sure he was eligible for VA benefits since his final discharge was classified as general.

With a detailed understanding of the patient’s SDoH barriers, Chris leveraged her CHW training and their combined knowledge of the social services and health care system to develop a promising plan of action. They decided he should be eligible for QMB through Medicaid; this would pay his Part A, B, and D expenses and most likely eligible for food stamps, rent assistance and heating assistance from the State. He would also be eligible for full VA benefits, including glasses, hearing aids, and medication, due to his 16 years of service.

As equipped patient advocates, they helped the man to navigate the complex system and educated him on how to articulate his needs with other healthcare and social service workers. On behalf of the patient, Mike made a call to the local Matura office and set up an appointment. He was able to expedite the process by providing the information obtained during Chris’ SDoH interview with the patient. “We were able to get him to the right people,” Mike says. “We reminded him to take his pay stubs and supporting documents to the appointment and told him what assistance he should request.” They advocated for the patient in similar ways to get connected for VA benefits, providing phone numbers and empowering the patient to take ownership of his health and well-being.

Needless to say, by having a CHW in the patient-centered community pharmacy, they were able to respond to the patient’s critical needs quickly and effectively. Ultimately, their efforts paid off for the patient. Since that seemingly helpless day, the patient now receives nearly $5,000 a month in VA benefits, Medicaid assistance, and more. “He should have had these benefits from the beginning, but he wasn’t able to navigate the system,” Mike points out. “All we promised him was an honest effort and we didn’t drop the ball. Without our help he would not have any food or medicine in the coming months.”

The patient is now able to afford his medicine and take it as his doctor was prescribing.

Cases like this one are plentiful. Community pharmacies across the nation are well-positioned to provide CHW-led interventions that close the gap in health disparities. Perhaps best stated by Mike, “there is a massive demand for this service and we know there are more patients that are not getting services because they are too proud to ask for help or believe there is no help out there for them. This is just another example of what community pharmacy does for the patient and the community.”

Yet, there is an unfavorable irony that deserves attention. They did all of this without being reimbursed for their service and then lost him as a patient. Due to VA benefit requirements, he now receives his medications through the VA. Alas, the community pharmacy lost revenue and miss out on the routine patient encounters that are the key to effective CHW interventions.

Mike and Chris Schweitzer are active members of CPESN Iowa, a Clinically Integrated Network of community pharmacies that empowers local, high-quality, patient-centered enhanced services. Bedford Drugs is a Cohort 2 graduate of the Flip the Pharmacy® program. Mike is a current Flip the Pharmacy Coach.