Going beyond medicine to improve U.S. health

Last year, the Journal of the American Medical Association reported that while the U.S. spends more on healthcare than other nations, we consistently experience poorer outcomes.

But it's not just a question of what we spend, it's how we spend it. Outcomes are not determined solely by healthcare consumption. Poverty, for instance, is linked to higher rates of cancer, cardiovascular disease, diabetes, asthma and other chronic conditions. And when spending to address social issues such as poverty and education are combined with healthcare spending, a different picture emerges, with U.S. spending ranking among the bottom third of all industrialized nations.

Changing the health picture in the U.S. means moving beyond medicine to fixing our systems through environmental, economic and emotional care. We don't incentivize this work, preferring to treat the illness rather than to prevent the cause. But there is momentum to change.

Take Catholic Health Partners in Cincinnati. The system has a low-income patient population affected by multiple chronic conditions, all exacerbated by social issues. In one case, when a patient lost her car and couldn't get groceries, go to her doctor's appointments or get to the pharmacy, the best prescription was transportation vouchers.

At Chicago's Mount Sinai Hospital, community residents have diabetes rates that are three times the national average. Their problem also required a nonclinical solution—a partnership with a local grocery store to offer healthy food and cooking classes.

The Premier alliance has a collaborative working to make these kinds of delivery-system transitions. We've learned that success requires health coaches who visit patients at home and ask if they know how to cook heart-healthy food. It requires integrated data, alerting clinicians when a prescription hasn't been filled or an appointment was missed. It requires doctors and nurses out in the community, providing care in churches, community centers and even on the street. It requires making care more accessible, culturally acceptable and less costly.

The healthcare debate has centered on the policy environment and the expansion of coverage. But change will take root only if it's addressed from the inside—by doctors, nurses and community organizations that choose to know the person beyond the diagnosis.