[PART 2] Using Innovation in Healthcare to Address the Needs of the Underserved

Thoughts & Take-Aways from Health Data Management’s Panel Discussion

Using Innovation in Healthcare to Address the Needs of the Underserved

Thoughts & Take-Aways from Health Data Management’s Panel Discussion

Part 2 of a 2-part series

 

Recently, I had the privilege of participating in a panel discussion hosted by Health Data Management. The discussion focused on harnessing innovation to better address the diverse healthcare needs of underserved populations. While the discussion took us down several paths, it centered on answering five principle questions:

  1. What’s the definition of “underserved?”
  2. Why is it important to understand and address underserved populations?
  3. How can (or should) we address the underlying or contributing factors?
  4. Where should we look for innovations addressing equity and care of the underserved?
  5. What opportunities and challenges are introduced by technology?

At Enli, we work alongside many progressive, mission-driven healthcare organizations, including several Federally Qualified Health Centers, Community Health Centers, and Behavioral Health Organizations that focus on underserved populations. Through them, the logic and technology that we build finds meaning when put into action—helping to address needs, improve health and lower healthcare cost. I am passionate about achieving health equity and so want to take the recent panel discussion beyond the walls of the Boston conference center.

In this article, I will focus on questions 3 through 5 highlighted above. For my thoughts on the first two discussion topics, you can read Part 1 of the series.

 

3) How can (or should) we address the underlying or contributing factors?

Underserved populations tend to be complex. The delivery of healthcare services to these populations is not the product of a simple math formula (a + b rarely equals c). There are many variables that should be considered when building strategies to close disparity gaps. The discussion panel identified the following factors:

  • Accommodate social and economic factors. Healthcare providers know the connection between unmet basic resource needs (e.g., nutrition, housing, transportation) and the health of their patients. Research suggests that more than 70% of health outcomes are attributable to the social and environmental factors.[i]  We are seeing more and more organizations finding creative ways to collect, analyze, risk stratify, and respond to social and economic challenges. 
  • Address behavioral health issues. Comorbidity between medical and mental conditions is the rule rather than the exception. In the 2001–2003 National Comorbidity Survey Replication (NCS-R) more than 68% of adults with a mental disorder reported having at least one general medical disorder, and 29% of those with a medical disorder had a comorbid mental health condition.[ii] 

 

Any plan to improve health and reduce cost will need to address mental illness and behavioral health.  This typically involves building new capabilities through additional skill-building, new care team members, as well as new partnerships and community connections. We are beginning to see more innovative partnerships between organizations that integrate services for physical and mental health emerge.

  • Respond to health literacy. Startlingly, nearly 9 out of 10 adults have trouble using the health information that is routinely provided.[iii] Obtaining, understanding, and interpreting health information and services are essential to making appropriate health decisions. Research indicates that commonly presented health information is not usable by most adults. Without understanding the information, people are more likely to skip necessary medical tests, end up in the emergency room more often, and have a harder time managing their chronic conditions.
  • Implement patient-focused, shared care plans. The ideal patient care plan seeks to build bridges between the medical treatment plan devised by the physician and the personal goals, preferences, priorities, and challenges of the individual.  It is important that patient-focused care plans are shared across a patient’s care team, so that each member of the care team is aware of, and concerned with, the whole plan. 

 

4) Where should we look for innovations addressing equity and care of the underserved?

We have learned that innovation will most often occur where the need is most acutely felt and the resources to invest most strained.[iv] In translation, that means it is unlikely that today’s powerful health plans and prestigious health systems will lead innovation initiatives. Instead, it is much more likely that innovation will come from those not invested in the current payment, process, people, and technology.

In the U.S., I continue to impressed by the innovation that I see in Federally Qualified and Community Health Centers. These organizations have pushed the conventional boundaries by integrating physical and behavioral care teams. They have stretched outside of healthcare to focus on other drivers of health by offering services such as transportation and housing. They cultivate community partners and implement low-cost solutions for meeting their patients where they are… even if that is on the street. Community health centers have demonstrated their ability to help mitigate costs while addressing the needs of the underserved: “…adjusting for health status, age, gender, race/ethnicity, and health insurance coverage, the average patient receiving care at a community health center had annual medical expenditures $1,093 lower than an average patient who did not use health centers…”[v]

Even more impressive are the healthcare payment and delivery projects underway outside of the U.S. In several developing countries, there are incredible examples of innovation that draw upon new technologies to deliver care plans and pay for healthcare, while avoiding the complexities of RVUs and claims as the basis for payment.

I have either led[vi] or joined groups[vii] trying to define THE technology framework REQUIRED to successfully pursue population health in service to triple (quadruple) aim outcomes. My growing fear is that these groups, staffed with prestigious organizations and monster vendors, will define a path that ignores the real innovative opportunities that are popping-up from the least likely places around the world.

 

5) What opportunities and challenges are introduced by technology?

Under contract to the Office of the National Coordinator for Health Information Technology, NORC at the University of Chicago prepared a briefing paper on the impact of health IT in underserved communities. The paper, based upon an extensive environmental scan and literature review, discusses the role of health information exchange, registries, electronic health records, clinical decision support, personal health records and consumer tools, as well as kiosks and mobile technology.

Certainly, there is a lot to unpack within the paper. Generally, however, it serves to affirm (or reaffirm) what experience has demonstrated to be true. Health IT provides us with tools to harness the power of data and offers the opportunity—when coupled with structural, financial, and clinical alignment—to improve health outcomes. Every organization can implement top-of-license team based care models leveraging population health technology to incorporate decision support into the everyday workflow. Information about patients can be gathered electronically before (or as) the patient arrives, simultaneously unburdening the busy care team while enabling collection of information that is critical to identifying and addressing individual patient needs.

Organizations should speak candidly with their electronic medical record vendor about making it easier to share information. It is essential that information related to patient-centered care plans be open to any/all members of a patient’s care team, however the patient defines their own team.

Jacquelyn Hunt, PharmD, MS, Enli Chief Population Health Officer


[i] Shi L, Macinko J, Starfield B, et al. The Relationship Between Primary Care, Income Inequality, and Mortality in US States, 1980–1995. J Am Board Fam Med. 2003;16:412-22.

[ii] Mental disorders and medical comorbidity. Research Synthesis Report No. 21. The Robert Wood Johnson Foundation.

[iii] Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. Washington, DC: National Center for Education Statistics, US Dept of Education, 2006. NCES publication 2006-483.

[iv] Clay Christenson’s Innovators Dilemma

[v] 2006 Medical Expenditure Panel Survey, http://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1023&context=sphhs_policy_ggrchn

[vi] Jacquelyn’s paper in Population Health

[vii] KLAS framework


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J. Hunt, PharmD, MS