Grow Healthy Together
Pathways Community HUB

Grow Healthy Together – Pathways Community HUB is a data driven community-wide system in Bexar County, Texas that connects low-income residents to needed medical care an social services to improve health outcomes through Community Health Workers (CHWs)

What factors are essential for effective cross-sector alignment?

Shared Purpose

  • The purpose of the Pathways Community HUB (HUB) is to provide a network of community-based organizations that hire and train community health workers (CHWs) to reach out to those at greatest risk assure that they connect to medical, social, and behavioral health services to reduce their risk.
  • Grew from a need to have objective measurement of community needs to support collective impact in an otherwise competitive environment. All participating organizations are required to be public-facing and serve those from the community.

Governance

  • The Bexar County Community Health Collaborative acts as the hub for all 80+ community partners.
  • The HUB Advisory Council provides governance; workgroups are responsible for specific activities.
  • Pathways HUB staff trains community health workers and their supervisors; care coordinators support team monitors quality of care; and community health workers are employed by clinical, social service, and community-based agencies.

Data

  • The HUB provides a unified system for community-based care coordination to provide data collection and enable information sharing within the region (all clients sign information agreements).
  • Shared data also used for whole coalition to identify priority areas (geographically), gaps in service, info for policy-makers, etc.
  • Pathways are standardized so outcomes can be compared across care coordinators’ agencies, communities, and hubs throughout the states and across the country.

Finance and Sustainability

  • The Bexar County Community Health Collaborative launched the HUB project with funding from Blue Cross Blue Shield.¬†
  • Organizations employing community health workers receive payments from Medicaid managed care plans and other funding partners when clients are successfully connected to services and achieve health outcomes.
  • For each completed pathway, the HUB assures at least 50% of payments are directly tied to health outcomes, creating a sustainable funding source for local providers.

Integration of Health Equity

  • Commits to elevating community voice and empowering community members
  • Has previously considered creating a Health Equity Alliance to keep track of issues, progress, and needs

Community Trust and Accountability

  • Includes people who are historically marginalized¬†
  • Strives to always listen, respond, and empower
  • Demonstrates their return on investment to investors, shares all the information about grants and grantees, and has a shared database to keep track of gaps in services

Measures of Success

  • Efficiency, capacity, services provided, number of people served
  • Financial return on investment
  • Health outcomes

Outcomes Achieved

  • Over 3,800 people using the HUB service