Massachusetts Community Health Program At Risk Of Ending

Jan 17, 2018

A wellness program in Massachusetts links together community resources to help people improve their health. It took a few years to get rolling and will soon have to end without new funding.

The awkwardly titled "Prevention and Wellness Trust Fund" was set up in 2012 as part of a Massachusetts law to reduce healthcare costs.

The idea was to make it easy for the medical, school and fitness worlds to communicate with each other.

That way, when doctors notice a chronic problem, like asthma or heart disease -- they can trigger a home visit by a community health worker, or someone from the YMCA will call a family to offer classes.

“It gives us the ability to support our patients much more efficiently,” said pediatrician Vinny Biggs, who is involved with the program in Holyoke -- one of nine locations around the state.

Before this program, Biggs said, he might identify a problem, like asthma, and urge patients to go home and look for the cause.

“I could write a letter for the family so they could go to the landlord and say, 'You know, please remove the carpets because we think that that's a trigger for the patient,'” Biggs said. “But that puts the onus completely on the family to have to do that.”

Community health workers like Aldenis Garcia can be more proactive.

“Basically, I go look under the sink, see if there's any dripping water, open up shower with the permission to see if there's any mold, any mildew,” Garcia said.  “We look for roaches, any mice droppings.”

And once they find a problem, the health worker will contact the landlord directly.

“Usually the landlords will come out and...take care of it,” he said.

On a recent morning, Garcia and a coworker entered an exam room at the Holyoke Health Center, where a 4-year-old boy was distracting himself with a Spiderman videogame.

“What’s your name? David?” Garcia said to the boy. “You’re here for asthma?”

His mom, Vionette, (who asked to keep their last name private) was scheduling a home visit with the health workers. She was eager to figure out why her son's asthma has gotten so bad.

“If I have something around the house that's causing it, I want to know so I can help him with that,” she said.

Vionette already cleaned the curtains and removed the rugs, she said, “but it's not the rugs. It has to be something else.”

She said her son was first hospitalized for asthma two years ago, but no one told her about the community wellness program until now.

“If I would've known a long time ago,” she said, “I would have had the help.”

Although the program began five years ago, Garcia, the community health worker, said sign-up has been slow.

“When I first came on board, we would call a family and they were like kind of like, ‘No,’” Garcia said, “because they don't know who I am, and they don't know what a community health worker is.”

And some were suspicious they'd have to pay for the services.

Now, Garcia said he works with about 30 families in Holyoke.

A state report found the program improved people's health and saved money. But it's not clear how long it will go on.

It used to be funded by a fee on insurance companies and large hospitals. That ended last July, in part due to opposition from insurers, according to state Representative Aaron Vega.

“At certain points, industries like insurance are going to be partners,” Vega said, “and at certain points they're not going to be a partner.”

Vega said he tried to get legislators to re-up the program last summer, but they couldn't agree how to pay for it.

“The program is definitely in a dire strait right now,” he said.

One possibility in the next state budget is a new tax on flavored cigars. No one is crazy about this funding method. For one, there's the irony of selling tobacco products to fund a health program.

And Vega said it's not clear how much revenue will come from such a niche market. But he said it could serve as a budget place-holder until a better option comes along.

“The politics of it is to keep the idea at the forefront,” Vega said.

A state spokesperson did not respond to questions on whether Massachusetts health officials have advocated for the Prevention and Wellness Trust Fund to continue.

In Holyoke, providers said they'll stretch the funding through June.

If the program has to shut down, even temporarily, health workers like Garcia worry it will be hard to get it rolling again -- especially when it comes to building relationships with families.

“You have something there. And then all of a sudden you're just going to take it away,” Garcia said. “So [families] are going to be like, ‘Well, I’m not going to trust them again,’ [and] they're not going to go with it.”

For now, community health workers are still making appointments and promoting better habits and conditions where they can.