An Up-and-coming Health Administrator Helps WakeMed Health & Hospitals Reach Out to the Homeless

WakeMed Health & Hospitals’ mission is to “improve the health and well-being of the community by providing outstanding and compassionate care to all.” Paige Carawan, a student in the George Washington University Milken Institute School of Public Health’s (Milken Institute SPH) Health Administration MHA program, is completing her residency as an Administrative Fellow at the North Carolina health system, and she knows firsthand just how active of a role her employer plays in furthering the health of its local community. In fact, she recently succeeded in receiving federal funding that is helping the health system to expand its outreach to the local homeless population.

“Paige has done a phenomenal job from start to finish with the Projects for Assistance in Transition from Homelessness (PATH) grant application,” says Becky Andrews, senior vice president and administrator, WakeMed Raleigh Campus. “She quickly grasped the concept of what this new community outreach program could mean for our community and she pulled together a team to provide input so the grant application process could be completed.”

The grant that WakeMed received thanks to Carawan’s successful application is from the U.S. Department of Health and Human Services (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) for its PATH program. This is the first proposal from a health system that SAMHSA has ever funded. Through the non-clinical program, WakeMed will expand its outreach to the homeless population in Wake County, which encompasses the state’s capital, Raleigh, and 11 other municipalities, including a significant part of the area’s Research Triangle region.

WakeMed is essentially the county’s safety net institution. The new grant funds WakeMed’s PATH Program, which is a part of WakeMed’s Community Population Health Initiative and under the health system’s Home Health division. The recent growth in these health system programs reflects the reality that between 2000 and 2014 North Carolina’s overall population grew by 25 percent while the state’s number of inpatient psychiatric beds decreased by 50 percent.

“Lack of stable housing, limited access to transportation, poor recognition of their mental illness, and cognitive impairments all prevent homeless individuals from seeking and receiving appropriate health care,” says Brian Klausner, MD, medical director for WakeMed’s Community Population Health Initiative. “Our emergency departments are often the first place people who are experiencing a behavioral health or substance use crisis go for help.”

Reaching out to people with no WakeMed connections

Team members in the new PATH program will seek out homeless people and develop relationships with individuals who may not know about services available to them through WakeMed and other resources. “Through PATH, we are hoping to engage people who have no connections to the hospital system,” Carawan says. “We understand that they initially might not want our help. Once we gain people’s trust, we can offer to engage them with health services and the basic needs to address their social determinants of health. This help may eventually aid some people in recovering who they were prior to homelessness.”

Both the Community Population Health Initiative and the PATH program are extensions of efforts begun in 2012 to help WakeMed better serve homeless individuals and provide treatment that helps them avoid ending up in an emergency room with an acute issue. The Community Population Health Initiative has been identifying frequent utilizers of the health system’s emergency departments (EDs) for the past three years. The program’s case managers meet with these patients outside the ED to determine their needs and help direct them to services that can aid them in dealing with issues before they become acute. The program has reduced the number of ED visits by high utilizers by 23 percent and cut high utilizers’ in-patient admissions by 51 percent, Carawan says.

“WakeMed has always been here for members of our community in times of medical crisis,” Dr. Klausner says.  “However, the individuals who are involved in our PATH program need ongoing specialized care beyond what WakeMed is able to provide as an acute care hospital. Through the use of case managers in the community, we are connecting people with mental health and substance use disorders to the resources they need so they can receive the services and care they need and deserve.”

WakeMed’s Community Population Health Initiative and PATH program really set the health system apart, observes Doug Anderson, an assistant professor at the Milken Institute SPH Department of Health Policy and Management. Anderson is serving as the interim director of the school’s residential MHA program and he is a noted expert on health administration. “This initiative and program address issues of population health, community benefit, and social determinants of health,” Anderson says. “This gives WakeMed much more of a public health focus than institutions following the traditional health services delivery model with which we are all familiar.”

Food, clothing and ID cards

The latest incarnation of the program made possible through the SAMHSA grant that Carawan wrote will fund six PATH team members in their efforts to seek out individuals who are 18 or older with either a serious mental illness or mental illness co-occurring with substance abuse. The services provided through the program include identifying the population’s basic needs and helping them meet those needs.  This can include aid with getting identification cards, food and clothing. Those who are interested in more can receive help with finding a place to live and even a job or training.  The ultimate goal of the PATH grant, which is distributed to all 50 states and has not traditionally been awarded to health systems, is to eliminate homelessness.

“Now that we have been awarded the grant, Paige continues to lead by preparing budget documents, identifying key supervisory staff, and more,” Andrews says.  “I am very impressed with the maturity level and skills she has brought to this entire project.”

For Carawan, the opportunity is particularly rewarding because, as she says:  “the whole reason I went into health administration is to help people who can’t help themselves.” However, as a native of Raleigh, N.C., which is part of WakeMed’s service region, her path to the health system was not the most direct.

Carawan initially planned to go into dentistry, but working in a dental office after completing her undergraduate studies at Clemson University inspired a shift in her thinking. What fascinated her the most, she realized, was working on insurance claims—especially after she helped her employer greatly reduce a significant backlog of accounts receivables. Carawan first learned about health administration as a career option when she read on Linked In that her undergraduate chemistry lab partner was pursuing an MHA. After she connected with him and learned more, she began investigating master’s programs in health administration. That eventually led her to the GW Milken Institute SPH’s MHA program. 

An administrator fostering public health

“It was important to me to pursue my MHA in a school of public health, because my goals in becoming an administrator include fostering public health and keeping the patient at the forefront,” Carawan says. Her favorite MHA class was Community Health Management & Advocacy (HSML 6212). “I appreciate what I learned about the social determinants of health, and I use it a great deal in my work at WakeMed,” she says. She also feels that what she learned at GW about the Medicare and Medicaid programs is very helpful in her current work with underserved populations. 

Carawan is the third MHA fellow from GW at WakeMed, and both of her predecessors are still there.  Her preceptors are Donald R. Gintzig, an alumnus of GW who serves as WakeMed’s president and chief executive officer, and Denise Warren, an executive vice president and chief operating officer. “I have the entire view of the operation from the top down.  I’m involved in leadership conversations and they value my opinion,” Carawan says. During her fellowship, she has interacted from everyone ranging from board members to cleaning staff.  “I see the health system from all different levels, and I’ve learned more here in 10 months than I ever could have learned in school.”

During her residency, Carawan made it her policy to say yes to any business task at least once. That is how she ended up writing the grant for the SAMHSA Projects for Assistance in Transition from Homelessness program. When Warren asked Carawan if she would attempt it because the organization’s grant writer had left, Carawan agreed to give it a go. After the grant was accepted, Carawan became involved in implementing the program the grant made possible, including interviewing candidates and hiring the team which is now just beginning to work at WakeMed.

WakeMed’s patient focus

WakeMed is a truly great place to work because “every action taken by everyone who works here, from the CEO down to a linen attendant, is with our patients in mind,” Carawan says. The hospital system does an outstanding job of both caring for patients and keeping them in the conversation about their care. She says that she hopes to stay at WakeMed for a long time.

Carawan credits Dr. Anderson for inspiring her to apply for the residency, and she hasn’t looked back since she first set foot in WakeMed to interview for the fellowship. “The culture is so strong; everybody is so dedicated to the mission. You can see and feel it. It is a true culture of service and exactly right for me,” Carawan says.

“GW’s MHA program is proud that a graduate student in our program is achieving this level of success on behalf of the organization where she is serving,” Anderson says. “Paige Carawan is obviously a great fit with WakeMed, and she’s the example of the kind of match we always strive to make between our students and the institutions that offer fellowships and residencies.”

UPDATE:  After this story was originally published, Carawan was offered a permanent position as the the Business Manager for Radiology at WakeMed.