PACT / USA

The Situation in the US

The US healthcare system is unstable and unsustainable. The proportion of GDP that healthcare expenditure accounts for annually continues to grow with little-to-no improvement witnessed in health outcomes or quality of life. Today, the sickest 10 percent of people receiving care in our hospitals account for roughly 50 percent of all healthcare expenditures.

This small portion of the population is often the most vulnerable and disproportionately burdened by disease; they suffer from multiple chronic illnesses, disabilities, language and cultural barriers, poverty, and mental and behavioral health issues.

The PACT Project’s Approach to the Most Vulnerable Patients

Based on the accompagnateur model pioneered in rural Haiti, the PACT project focuses on effectively integrating community health workers (CHWs) into primary care and mental health teams.

PACT partners with clinics to develop the infrastructure, culture, quality improvement tools, and skills necessary to support effective CHW interventions for the most vulnerable patients. PACT believes that well-supported and well-integrated CHWs enable care teams to improve their patients’ health outcomes, engagement, and expenditures on healthcare.

PACT has enabled several organizations to better accompany their most at-risk patients, including:

PACT’s Commitment to the Boston HIV/AIDS Community

Since 1997, PACT has recruited and trained CHWs to work with the most vulnerable HIV/AIDS patients in Boston – individuals who suffer from mental illness, substance use, stigma and poverty and who are dying despite readily available care and life-saving medications. CHWs accompany patients as they reclaim their health, improve their disease-management skills, develop meaningful relationships with the healthcare system, and improve their wellbeing.

PACT’s community-based approach has been proven to improve the health of their clients at reduced costs to Massachusetts’s Medicaid program (MassHealth). One year post-enrollment in PACT’s HIV program, 70% of patients witness significant improvement in their health (viral load suppression and CD4 improvements). Analysis of Medicaid claims reveals a 16% net savings in total medical expenditure two years after enrollment. This is attributed to a 35% reduction in length of stay and inpatient costs.

PACT’s Accompaniment of the NYC Department of Health

In early 2007, PACT staff trained CHWs and managers at three NYC HIV clinics in order to pilot the integration of CHWs into existing HIV care management programs. Following a successful pilot phase, the DOHMH released a RFP to all publicly funded HIV clinics to receive care coordination money to adopt a hybrid PACT/care coordination model – 28 clinics applied and were funded. Since then, PACT has provided ongoing training and technical assistance to the DOHMH program management and training staff.

Learn more about PACT's work.