Hangar Team Spotlight - Lisa Renee Holderby-Fox on Technology and Public Health
Hangar Team Spotlight:
Lisa Renee Holderby-Fox on Technology and Public Health
For this week’s team spotlight Q&A, we spoke with Lisa Renee Holderby-Fox, Director of Health and Engagement at Roster, a Hangar portfolio company that pairs specialized technology systems with dedicated community health workers to deliver effective and accessible value-based health care.
As an acclaimed national leader in the community health worker (CHW) movement, Lisa Renee brings three decades of experience promoting health equity and community health worker workforce advocacy to Roster.
Can you tell us a bit about your career and your path to Roster?
My background is in maternal and child health, I’ve conducted home visits, street outreach and everything in between. I’ve worked for a public health association, community-based organizations as well as established federal programs that focus on women’s and children’s health promotion.
I’ve been a community health worker for almost thirty years. But to be honest, I didn’t start hearing the term “community health worker” until 2000. Around this same time, I realized that there were a lot of people out there doing the same work as I was although we had many different job titles. Collectively, we realized that we needed a unified voice. So, I joined with others and began organizing community health workers in Massachusetts. This effort later grew into the statewide professional organization for CHWs, the Massachusetts Association of Community Health Workers (MACHW). As a co-founder of MACHW, I served on the board of directors for several years. In 2005, I became one of the first community health workers in the country to be hired as a full-time executive director of a statewide association for CHWs.
In this role, as the “CHW for CHWs” I sought opportunities to support the CHW workforce through policy development. This work provided the opportunity to draft policies to support and recognize the work CHWs do in communities. A few accomplishments I’m most proud of are drafting of two CHW bills, signed into law in Massachusetts and representing CHWs on the National Healthcare Workforce Commission created in the Affordable Care Act (ACA).
While organizing CHWs in Massachusetts and attending national conferences I met CHWs from across the country. I began to understand that the issues we faced in Massachusetts -- like how to integrate community health workers into broader health equity efforts, sustainable funding, and appropriate professional development opportunities -- were prevalent across the country. I became involved with individuals and groups working on these issues nationally. Ultimately, I became one of the national leaders in the community health worker movement. Along with several other CHW leaders from across the country I’m a co-founder of the National Association of Community Health Workers (NACHW).
I was really excited when I was first introduced to Roster. The company was focusing on partnering CHWs with technology to tackle the social determinants of health. Roster was also seeking alternative payment strategies for CHWs. Most CHWs are currently funded with grants. As you can imagine, that’s not sustainable for the workforce or the communities we serve. Roster’s work fit into everything that I’d been working for my whole career, promoting health and individuals, families, communities, funding full-time CHW positions with sustainable dollars and fully integrating CHWs as team members.
What is your role at Roster?
As the Director of Health and Engagement at Roster, I help connect our work to what’s needed and what’s happening on the ground -- and not just for individuals, but from a community-level perspective as well. I bring a non-clinical perspective to our team. We know that much of what determines an individual’s health happens outside of the walls of the health care provider’s office. In order to integrate and address social determinants of health (SDoH), experts in this area should be integrated into teams. CHWs are those experts. I leverage my connection to and knowledge of the CHW workforce.
For instance, when the pandemic started, Roster wanted to jump in and roll up our sleeves to help. I had worked with a rural community health worker organization in Arkansas and saw that they were facing challenges connecting community members virtually to doctors and resources. So, Roster assisted them to get tablets, develop an electronic resource directory and worked with a local provider so that he could conduct virtual visits with community members. That’s just one example of leveraging my extensive CHW network to help Roster make a difference.
Where do health equity and technology intersect?
We’re thinking strategically about how leveraging technology can impact health equity. How Roster can bring a unique perspective to that work. My role is to assist our technology team to better understand the needs and challenges of community health workers and others doing the work on the ground. This is the only way they can create meaningful solutions that can really support and enhance the work. In doing this, it’s important to think through the lens of equity and community. I know that the best technology in the world will not change health inequity and shift that paradigm, but the best technology in the world in the hands of people going out to do that work? That’s what can really have an impact and promote health equity.
Technology, AI, machine learning -- that’s where we’re all going. Isn’t it best that people who have an eye to doing the right thing, protecting privacy and not marginalizing communities are doing that work? In order to achieve that, you need different lenses, different perspectives and different expertise in the room. I bring on-the-ground knowledge, life experiences and CHW expertise to the table.
How has the community health worker movement and community been impacted by the pandemic?
Community health workers have been extremely engaged throughout the pandemic, first providing awareness, then testing and vaccines, now ongoing education. Community health workers are able to reach people that may be left behind by a social media splash or ads that are in areas of the city where some communities may not often go. We’re still going door to door to talk to folks, going to the same places and working with the same populations who may often be overlooked, but who community health workers have always worked with. We know how those communities talk about COVID and how they talk about vaccines, so we want to make sure to meet people where they are, speak their same language and get them the information and resources they need. This is the work we’ve been doing all along, now we’re just doing it with more recognition from others, including the federal government.
Because of the pandemic, everyone is interested in learning more about community health workers. They want to elevate our work and they want to pay for our work. I’m excited by that, but I’ve also seen this happen in the past. Something bubbles up, and all of a sudden, all of this funding comes in for community health workers. However, when people perceive that the immediate issue has gotten better, the funding stops. What I’m hoping is that this pandemic has opened everybody's eyes to the reality that this can happen again. And even if it’s not another pandemic, there are other ways that community health workers can assist communities in times of crisis, such as during natural disasters. Community health workers can and should always be engaged to assist, with sustainable funding to support the work.
Where do we go from here and what are you looking forward to?
One of the things that really excites me about our work at Roster is that, ultimately, we want to get better technology into the hands of various practitioners, including community health workers. People often develop things for community health workers, whether it be technology, training, or programs, without community health workers at the table. It doesn’t make sense to develop something for community health workers without CHW leadership. That’s different here, and that’s important because that's not happening everywhere, particularly where technology is concerned. Having practitioner voices, including a CHW at the table, is a differentiator for Roster and essential to the work that we’re doing to promote health equity through tech and touch.