Big Health systems in the US are investing more in community health. This comes as Kaiser Permante Southern California, one of the largest managed-care organizations in the US, found that only 1% of the patient population accounts for approximately 25% of the organisation’s annual medical costs.

This cost however, is often not associated with medical factors. The Robert Wood Johnson Foundation, the largest U.S. philanthropic funding body focused on health has estimated that 20% of an individual’s health is influenced by medical factors with other social, behavioural and environmental factors driving the need for medical care. Healthcare systems that have identified high costs to their medical expenses are trialling “community cures” for healthcare.

A need to address community and social issues

Kaiser Permante Southern California intends to address the issues that are driving up health care costs by partnering with non-profit organisations such as Health Leads, which screens high-risk patients for a range of needs and connects them community resources and social services. Kaiser is identifying and working with Health Leads to target “high utilisers” of health care services.

Artair Rogers, a senior consultant at KP Southern California explained, “We want to see if we can start showing, in a short period of time, that it makes business sense to invest in this targeted and personalised approach.”

In Kaiser’s case, they worked with diabetic patients whose medical costs were estimated to be within the top 1% of its entire patient population. It was determined that more than half of these diabetic patients had two or more social needs, such as the need for better housing or counselling.

This prevalence was much higher that Kaiser had expected. Although too soon to determine the effectiveness of the program, a similar initiative conducted by Health Leads at the Massachusetts General Hospital in Boston has reported improved cholesterol and blood pressure levels among patients.

Hunger and poor nutrition, a source of hospital visits

ProMedica, a non-profit healthcare system, has decided to focus on a universal screening approach, identifying hunger and poor nutrition.

ProMedica and decided to act after a study showed that a large proportion of patients lived on low-cost junk food diets, which as a result, caused higher-than-average rates of obesity, diabetes, heart disease, and back issues. ProMedica serves 1.5 million people and now screens all patients for hunger and poor nutrition. It has found within the first nine months that 1,500 of its patients (4.1%) suffered from chronic hunger.

“When you look at poverty, there are so many [overwhelming] issues—education, crime, underemployment, and so on. But hunger [and malnutrition] was something we could get our arms around. We can screen every single patient we touch for hunger,” said Randy Oostra, ProMedica’s president and CEO.

ProMedica is setting up a number of on-site food pantries for low-income patients, offering nutrition counselling and are also opening a supermarket in a low-income area that previously had none.

Implications for the future of healthcare communities

Another organisation that has joined in this effort is NYC Health + Hospitals, a public system that serves roughly 1.4 million people is working with Health Leads to undertake a targeted approach to social needs.

Dr. Arthur H. Fierman, Bellevue’s medical director of Paediatric Ambulatory Care said, “The impact was immediately noticeable, everyone was happy to have this additional resource to take over the tasks that used to be shared by social workers, nurses, and doctors, or not addressed at all, and to expand the list of things that we could help patients address.

“This has been a culture change,” he stressed. “Now providers can address basic needs in a more active way, and they can feel confident in making the referrals.”

After identifying causes of patients in need of help, health systems that wish to address the social needs of its patients will have to integrate the solution with their core clinical systems and processes.

“At the end of the day, health care executives have to run the business. If the work on social needs reduces utilisation and emergency department visits, you start to find a business model that is effective” said Dr. Ross Wilson, chief medical officer of NYC Health + Hospitals. MIMS

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