Health centers have integrated Enabling Services (ES) as a diverse workforce to address social determinants of health. The ES workforce is generally composed of Community Health Workers, Case Managers, Patients and Community Education Specialists, Transportation Workers, Eligibility Assistance Workers, Interpretation Staff, and other programs and related services staff. The services performed by ES staff provide support to the clinical care team (primary care) and facilitate patients’ access to care. These services include case management, eligibility assistance, health education, outreach, translation, and transportation, among other services. Health centers provide primary and preventive care to diverse populations, including low‐income, racially and ethnically diverse, and uninsured populations. These special populations may face myriad cultural, economic, and linguistic barriers that may inhibit patients from achieving good health. Therefore, ES staff have the potential to bridge this gap and link patients to care and continuity of care for improved health outcomes.  

This episode will provide an overview of the different roles and responsibilities ES staff play on care teams and their impact on health outcomes, service delivery and care, and cost‐effectiveness. Listeners will take away a better understanding of how ES staff is integrated into care teams and their valuable contributions. 

Season 1, Episode 7: The Impact of Enabling Services

Guest: Esly Reyes from MHP Salud

Click the link for additional resources on Enabling Services Impact from MHP Salud. All resources are available and free to PCAs, HCCNs, and health centers.

Learning Objectives: 

• Identify ES staff roles and responsibilities within care teams. 

• Understand how ES can positively impact health outcomes, service delivery and care, and costeffectiveness. • Identify tools and strategies to demonstrate ES value. 

• Recognize how ES can contribute to achieving program and organizational goals. 

Enabling Services, defined as non‐clinical services that aim to increase access to health care and improve health outcomes, are a hallmark of community health centers, connecting vulnerable patients to supports that enhance their ability to become active partners in their own health care. Patients with chronic conditions may require Enabling Services such as care coordination, language assistance services, transportation, and/or other supports to help them fully adhere to their clinical treatment plans. Community health centers effectively address patients’ social determinants of health barriers and can benefit from a standardized protocol to systematically document those interventions. 

The ability to track and evaluate these services is essential in order for health centers to demonstrate their value in meeting and addressing patient social risks. The Association of Asian Pacific Community Organizations (AAPCHO) offers an Enabling Services Data Collection (ESDC) tool and best practices for community health centers. 

Season 1, Episode 6: Data and Enabling Services

Guests: Albert Ayson and Joe Lee from AAPCHO

Click the link for additional resources on ESDC from AAPCHO. All resources are available and free to PCAs, HCCNs, and health centers.

Learning Objectives: 

• Explain the importance of Enabling Services data collection and documentation in order to understand the Social Determinants of Health needs of patients and demonstrate the value of enabling services that address them. 

• Identify training and technical assistance resources to launch or expand an ESDC initiative for Primary Care Associations and their community health centers. 

• Describe the updated ESDC standardized protocol, identify the role of Enabling Services in organizational readiness for value‐based healthcare transformation, and gain hands‐on practice for data documentation. 

Robust, community‐driven outreach models are critical for ensuring access to and utilization of health care services by underserved populations. However, under a traditional structure of payment for health services, many outreach activities and other enabling services are non‐reimbursable. However, over the past decade, there has been a national shift in the ways in which health care is delivered and reimbursed. New service delivery systems and alternative payment models afford health centers the opportunity to provide patient‐centered care in a more flexible manner, including the use of health outreach programs and enabling services provision. 

The guest will review payment reform through focusing on enabling services and highlight possible roles for health center outreach and ES staff in alternative payment models such as shared savings models, and patient centered medical home and evidence‐based primary care delivery models, Medicaid Managed Care Organization (MCOs), Accountable Care Organizations (ACOs), changes in reimbursement codes to capture new data such as Z codes. HOP will give examples of how health centers can leverage outreach and enabling services to earn payment while improving access to care for patients served.   

Season 1, Episode 5: Value-Based Care and Enabling Services

Guest: Kristina Wharton from HOP

Click the link for additional resources on Value-Based Care from Health Outreach Partners.All resources are available and free to PCAs, HCCNs, and health centers.

Learning Objectives: 

• Define “Value‐Based Care” and describe its place in outreach and enabling services. 

• Provide overview and examples of VBC models of relevance to PCA and health center outreach and enabling services staff. 

This episode explores the role of legal services in addressing social determinants of health. Listeners will hear from Ellen Lawton, lawyer and leader in the field of medical-legal partnerships, who will describe the core components of the MLP approach, how health centers can integrate community legal services into their on‐going SDOH work, and how to think about measuring the value of legal services in the health center context. The discussion will focus on how to align enabling services screening, data collection and interventions with MLP services within a specific population or SDOH domain. Special focus is given to the role of PCAs in supporting health center MLP. Listeners are directed to the National Center for Medical‐Legal Partnership's resources to identify steps to determine readiness for adoption, and to find case studies from local program leaders about what works and what does not. 

Season 1, Episode 4: Medical-Legal Partnership & Health Centers

Guest: Ellen Lawton from the National Center for Medical Legal Partnership (NCMLP) at The George Washington University

Click the link for additional resources on Medical Legal Partnership from NCMLP. All resources are available and free to PCAs, HCCNs, and health centers.

Learning Objectives: 

• Participants will be able to describe three ways social determinants like housing or income can be addressed by working with legal professionals. 

• Participants will learn how enabling services programs incorporate MLP into health center SDOH activities.  

• Participants will be able to identify opportunities to improve SDOH capacity by leveraging community legal resources. 

By mission and mandate, health centers provide non‐clinical, enabling services to help ensure the accessibility and effectiveness of clinical services. These services include outreach, enrollment assistance, case management, interpretation, transportation, health education, peer support, and more. In a policy and funding environment for health care that continues to change, it is critical that health centers provide evidence‐based enabling services that are known to result in better outcomes and increased value. 

This episode is presented by NACHC on the policy developments and operational considerations that help to inform and strengthen the role of health centers in providing enabling services to their communities and the role of PCAs.  Additionally, NACHC policy experts address the impact of COVID-19 on policies and health center services including enabling services. 

Season 1, Episode 3: Operational and Policy-Related Updates

Guests: Bethany Hamilton and Ted Henson from the National Association of Community Health Centers (NACHC)

Click the link for additional resources on Structural Competency from NACHC. All resources are available and free to PCAs, HCCNs, and health centers.

Learning Objectives: 

• Highlight current policies affecting health center enabling services. 

• Understand the operational issues and models for providing health center enabling services. 

• Provide ideas on how to elevate enabling services as a solution. 

Health center efforts to advance health equity and address health disparities must include an analysis of the structural factors—social, economic, and political systems—that impact the health and quality of life of their patients and communities. Approaches related to cultural competency and social determinants of health are touted as effective ways to explain and address health disparities. Yet they are limited and often do not include an analysis of the root causes of poverty and inequities, which are largely due to policies, systems, and social hierarchies of structural racism, power, and privilege. 

In this episode, listeners will be introduced to the Structural Competency framework and related key concepts, including defining and discussing structural racism, naturalizing inequality, and structural violence and vulnerability. Listeners will develop a broader understanding of structures and have a lens and shared language to use in order to be better advocate for their patients and communities. Listeners will be able to apply the framework to identify individual, clinic, community, research and policy‐level initiatives relevant to health center programs and enabling services. The Structural Competency framework aims to strengthen the capacity of all health center and PCA staff—administrators, clinicians, and outreach workers—to identify, analyze, and address patient health and illness not solely as the outcome of individual actions or cultural factors, but rather as the product of social, political, and economic structures. Health center and PCA staff are trained in structural competency can (1) improve the work experience; (2) improve patient health outcomes; and (3) empower other staff and community partners to advocate for systemic change. 

Season 1, Episode 2: Structural Competency

Guest: Sonia Lee from Health Outreach Partners

Click the link for additional resources on Structural Competency from Health Outreach Partners.

Learning Objectives: 

• Discuss the Structural Competency framework and define the key concepts of structural violence, structural racism, structural vulnerability, and naturalizing inequality. 

• Conceptualize how to deliver care such as outreach and enabling services and advocate for communities using a structural competency lens. 

• Identify and discuss structural interventions pertinent to participants’ health centers and PCAs.

Health and health behaviors are influenced by more than just genetics and clinical care. They are largely influenced by social, economic, and environmental factors that impact patients’ ability to access care and services. Health centers address these issues of access through a range of methods, including the provision of enabling services. 

AAPCHO and HOP will kick off the PCA Enabling Services Summit by providing a concise definition of Enabling Services (ES): non‐clinical services that support the delivery of basic health services and facilitate access to comprehensive patient care as well as social services. Enabling Services include case management, benefit counseling or eligibility assistance, health education and supportive counseling, interpretation, outreach, transportation, and education of patients and the community regarding the availability and appropriate use of health services. They often serve to “bring patients in the door,” but can also bring the care to the patients. In breaking down both common and personal barriers to care, Enabling Services are particularly important for those communities that experience the most acute health disparities in terms of access and outcomes. These include the poor, members of racial and ethnic minority groups, the uninsured and under-insured, and geographically and culturally isolated populations, people living with multiple and complex chronic conditions – the very communities served by health centers, making Enabling Services essential to health centers’ missions. 

Season 1, Episode 1: Enabling Services Overview

Guests: Joe Lee from AAPCHO and Kristina Wharton from HOP

Click the link for additional resources on Enabling Services from AAPCHO and HOP. All resources are available and free to PCAs, HCCNs, and health centers.

Learning Objectives: 

• Define what Enabling Services are and how they serve health center patients. 

• Describe the importance of the role of enabling services to bridge access to care. 

• Provide a preview on demonstrating the value of enabling services for health centers and the role of PCAs in supporting enabling services.