In Depth: Hospitals tackling social determinants are setting the course for the industry
Skip to main content
MDHC_Logotype_white
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • This Week's News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • The neurologist will you see now, virtually
      Oregon: CDC investigating woman's death after J&J vaccine
      California goes from worst to first in virus infections
      Healthcare leaders: Help your people get comfortable with uncomfortable conversations
    • The neurologist will you see now, virtually
      Oregon: CDC investigating woman's death after J&J vaccine
      California goes from worst to first in virus infections
      Health system execs prioritize service line consolidation
    • Wyo. hospital offers bonus to healthcare workers willing to get vaccinated before summer
      Alaska tribal health groups distribute vaccine far and wide
      Some healthcare associations moving full steam ahead with conferences starting in summer
      COVID hospitalizations in Michigan top fall surge; Beaumont seeing nurse 'burnout'
    • Navigators to get record-breaking $80 million to boost ACA enrollment
      New enrollments push Anthem beyond expectations in Q1
      Insurers spent more on lobbying as Congress debated ACA and COBRA subsidies
      BCBSA wants to cut racial gap in maternal care by half in five years
    • California goes from worst to first in virus infections
      Premier asks CMS to give ACOs more time to prep for new MSSP quality reporting requirements
      Navigators to get record-breaking $80 million to boost ACA enrollment
      Healthcare workers in a triage dialysis center.
      Gaps in disaster preparedness leave patients at risk
    • Beyond the Byline: How fee-for-service can mute population health gains
      Johnson & Johnson Q1 profit, sales jump, beat Street views
      Private equity's estimated healthcare spending halved in first quarter
      UH reports $54.7M operating income for 2020 despite significant COVID-related costs
    • One state eyes increasing telehealth in community health centers
      A case study in HIE consolidation
      Dr. David Brailer
      Q&A: First ONC head Brailer's vision for information sharing
      Claudia Williams writing on whiteboard in a room filled with people during a planning session.
      Momentum returns for health information exchanges
    • Oregon: CDC investigating woman's death after J&J vaccine
      Premier asks CMS to give ACOs more time to prep for new MSSP quality reporting requirements
      New data reassuring for COVID-19 vaccination in pregnancy
      New project seeks to build climate resilience at community health clinics
    • Tenet's general counsel to retire at end of year
      Oscar names new virtual-first care division president
      Redfield joins Big Ass Fans, which promotes controversial COVID-killing technology
      Next Up Podcast: Modern Healthcare's editor Aurora Aguilar talks new content direction
    • Midwest
    • Northeast
    • South
    • West
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
    • The Affordable Care Act after 10 years
    • A close-up of a woman receiving a COVID-19 vaccine.
      Providers in underserved communities work toward equitable vaccine distribution
      Josh Bradshaw
      How one rural Illinois county vaccinated 84% of its senior citizens by early March
      Dr. John Fischer
      Patient-reported outcomes tool for hernia surgery helps physicians improve care
      New care model helps primary-care practices treat obesity
    • Arrows made of binary code.
      Collaboration across the C-suite key to implementing data blocking, interoperability rules
      A graphic that includes a man in a wheelchair and images of binary code.
      Post-acute facilities face hurdles in healthcare's interoperability push
      A family photo of the the Hangens.
      Stressing the already burdened pediatric behavioral health system
      Jennifer Pannone and her daughter Victoria.
      Mental health access for children needs attention
    • Ryan McGinnis
      Finding efficiencies in the OR using tech
      Dr. Daniel Hall
      UPMC pilots machine learning, telehealth to inform patient transfers
      A woman being recorded using her inhaler on a smartphone.
      Digital check-ins, connected inhalers help control asthma
      A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Mayo Clinic launches two tech companies
      Diabetes patients at high risk for COVID-19 are managing conditions more effectively
      Nearly 1 in 5 Americans skipped care due to cost last year
      COVID-19 long-haulers need holistic treatment, providers say
    • Health system execs prioritize service line consolidation
      Telehealth increases downstream care, study finds
      Amazon gives out $12M under next phase of AWS diagnostics development initiative
      Malpractice premiums peak in 2020, AMA survey shows
    • The neurologist will you see now, virtually
      Hospitals face specialty pharmacy challenges with insurer competition
      Addressing long-standing barriers needed for mental and physical health integration
      A close-up of a woman receiving a COVID-19 vaccine.
      Providers in underserved communities work toward equitable vaccine distribution
    • Payers, providers clash over telehealth reimbursement as Congress mulls changes
      When money talks. Why cash pay is becoming more popular
      CMS wants to bump pay for hospices, SNFs next year
      CMMI pauses new Direct Contracting model applications
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
    • Health Systems Financials
      Executive Compensation
      Physician Compensation
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Dr. Alan Kaplan
      The risks, rewards of taking organizations 'where they haven’t gone before'
      Wellstar CEO calls adapting for the pandemic her bold move
      Howard P. Kern
      Recognizing the value of telehealth in its infancy
      Dr. Stephen Markovich
      A bold move helped take him from family doctor to OhioHealth CEO
    • Paul Tufano
      Healthcare's most important prescription—empathy
      Drs. Hal Paz and Joshua J. Joseph
      Mobilized to fight the COVID crisis: a blueprint for community and academic partnerships
      Dr. Stephen Markovich
      Making sure we're aligned along the path to achieving inclusion
      Barry Ostrowsky
      Ending racism is a journey taken together; the starting point must be now
    • The power of partnership in improving behavioral health access
      Cassie Leonard
      Removing an obstacle that impedes IT interoperability and vaccination efforts
      Reed Hartley
      Data is the key to repairing the nation's healthcare system
      It's time we fulfill the ACA's promise to broaden access to lower-cost drugs
    • Letters: Eliminating bias in healthcare needs to be ‘deliberate and organic’
      Letters: Maybe dropping out of ACOs is a good thing for patients
      Letters: White House and Congress share blame for lack of national COVID strategy
      Letters: VA making strides to improve state veterans home inspections
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Award Programs
    • Nominate
    • Previous Award Programs
    • Other Award Programs
    • Nominations Open - Top 25 Innovators
      Nominations Open May 10 - Top 25 Minority Leaders
      Nominations Open May 24 - Top 25 Emerging Leaders
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Minorities in Healthcare
      • - Luminaries
      • - Top 25 Minority Leaders
      • - Minorities to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • COVID-19 Event Tracker
    • Sponsored Content
      Webinar: Optimizing your COVID-19 vaccine outreach
      emburse certify modern healthcare custom media webinar logo lockup
      Sponsored Content Provided By Emburse
      Webinar: Making it easy to manage expenses
      virtualmed staff modern healthcare custom media logo lockup
      Sponsored Content Provided By VirtualMed Staff
      Webinar: Best practices for creating a successful telepsychiatry program
      Webinar: Avoid interoperability penalties. Modern Healthcare. Sponsored by Hall Render
      Webinar: Avoiding interoperability penalties
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Healthcare Transformation Summit
    • Leadership Symposium
    • Virtual Briefings
      • - Hospital of the Future
      • - Mental Health
      • - Patient Safety & Quality
      • - Strategic Marketing
      • - Virtual Health
      • - Workplace of the Future
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Minority Leaders Gala
    • Top 25 Women Leaders Gala
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
    • Next Up Podcast: Managing the COVID-19 vaccination rollout with Dr. Gary Little
      Next Up Podcast: Modern Healthcare's editor Aurora Aguilar talks new content direction
      Dr. Chris DeRienzo
      Next Up Podcast: Building team spirit in the wake of COVID-19
      Mikelle Moore
      Next Up Podcast: Mikelle Moore on recognizing all hospital workers during the pandemic
    • Beyond the Byline: How fee-for-service can mute population health gains
      Beyond the Byline: Kids' unchecked mental health needs pose long-term consequences
      Beyond the Byline: How COVID-19 has impacted hospital finances
      An older man sitting on a hospital bed with his back toward the camera.
      Beyond the Byline: Upcoding could explain why hospitals are increasingly billing for the most complex treatment
    • James garvert neustar healthcare insider podcast image
      Building on basics
      Healthcare Insider Podcast Episode Art - Premier
      Why Roger Weems and other consultants are leaving the big firms to join Premier
      James garvert neustar healthcare insider podcast image
      Outreach during COVID-19
      ann barnes healthcare insider podcast image
      Leading with intention to promote diversity and inclusion
    • The Check Up: Kevin Shimamoto
      The Check Up: Kevin Shimamoto of Valley Children's Hospital
      The Check Up: Dr. James E.K. Hildreth
      The Check Up: Dr. James E.K. Hildreth of Meharry Medical College
      The Check Up: Matt Eyles
      The Check Up: Matt Eyles of AHIP
      The Check Up: Dr. Tom Shanley
      The Check Up: Dr. Tom Shanley of Lurie Children’s Hospital of Chicago
    • ivana naeymi-rad one on one intelligent medical objects
      Video: Ivana Naeymi Rad of Intelligent Medical Objects
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Providers
August 25, 2018 01:00 AM

In Depth: Hospitals tackling social determinants are setting the course for the industry

Steven Ross Johnson
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print
    Bill Healy

    Chimera Campbell

    Dealing with cold winters was not Chimera Campbell's biggest challenge after moving from Florida to Chicago in 2012.

    The 39-year-old couldn't manage her asthma, and that led to frequent emergency visits to Mount Sinai Hospital, a part of Sinai Health System. “I was in the ER constantly with chest tightness, pain and having problems breathing,” Campbell said, estimating she visited the ER six times a year.

    Then, Campbell received a phone call from a staffer for the safety-net system asking whether a community health worker could visit her home and identify and get rid of any environmental factors that could be aggravating her asthma.

    Campbell agreed and the worker, Kim Artis, discovered that household dust and secondhand smoke were the culprits. “Patients don't come into the clinic saying their house is dusty or their husband is a smoker,” Artis said. “So that is the missing link we provide once we go to the home.”

    Since working with Artis for the past two years, Campbell has not visited the ED for her asthma. Artis “helps me with my health, my mind, the body and my spirit,” Campbell said.

    Systems adopting such unconventional approaches to managing chronic disease are becoming less unusual as the concept of addressing social determinants of health sweeps the industry. Income, education, employment, food security, housing stability and violence are all targeted factors to help improve patient health.

     

    What are social determinants of health?

    Having difficulty paying rent or affording a place of one's own, living in overcrowded or run-down conditions

    Not having reliable access to enough affordable, nutritious food

    Not having affordable and reliable ways to get to medical appointments or purchase healthy food

    Not having access to high school classes or other training

    Not being able to regularly pay utility bills

    Being exposed to use of physical force or power that results in or has a high likelihood of resulting in injury or death

    Not having relationships that provide interaction and nurturing

    Not having the ability to get a keep or job


    Source: Deloitte Center for Health Solutions

    But addressing issues that can't be managed within the walls of hospitals and clinics has proven costly and so far has shown scattered results.

    “At this point a lot of providers aren't sure how to fully engage and what actions do they actually do to make themselves ROI-positive,” said Anita Cattrell, chief innovation officer at Evolent Health, a managed services company that helps systems transition to value-based care.

     

    The role of social determinants

     

    Individual behaviors are the largest contributors to premature death, accounting for 40%, according to a 2007 New England Journal of Medicine story, while healthcare made up just 10%.

    The concept of social determinants of health was first introduced to U.S. policy in the 1960s when President Lyndon B. Johnson declared a War of Poverty that brought about Medicaid, Medicare, food stamps, Job Corps and Head Start.

    “There was a recognition in this country that problems of violence, abuse and lack of access to good nutrition, housing and transportation were harmful to people living in certain areas,” said Rita Numerof, a St. Louis-based healthcare consultant.

    But it wasn't until 20 years later that hospitals began hiring social workers to connect patients with community support services.

    And then came a policy that pushed hospitals to concentrate on volume. In 1983, the CMS implemented the diagnosis-related group, or DRG, as its method for reimbursing providers. “One of the problems was that there was no connection between payment and outcomes,” Numerof said.

    Tracking the progress of social determinants of health

    1800s The founders of modern public health stress the correlation between a person's social position and her or his health outcomes.

    1945 The United Nations Conference on International Organization suggests creating a global health organization.

    1948 The World Health Organization kicks off with a constitution that defines health as “a state of complete physical, mental and social well-being.” The group will promote “the improvement of nutrition, housing, sanitation, recreation, economic or working conditions and other aspects of environmental hygiene,” to achieve optimal health.

    1957 Two Democratic congressmen propose a national health insurance program for older Americans because so many seniors have chronic health conditions and can't afford the cost of hospitalization. This led to the creation of Medicare in 1965.

    1960s and '70s Community organizers in developing countries such as India, Mexico and the Philippines work to promote social and environmental determinants of health and mobilize to take on political and economic issues.

    1962 Michael Harrington's book The Other America demonstrated that poverty was far more widespread than commonly assumed. It spurred Presidents John F. Kennedy and Lyndon B. Johnson to formulate an anti-poverty agenda, which led to Johnson's War on Poverty. As a result, Congress created Medicare and Medicaid; expanded Social Security benefits; passed the Food Stamp Act; and established the Job Corps, Head Start and other anti-poverty programs.

    1976 Danish public health advocate Dr. Halfdan Mahler becomes director-general of the WHO and proposes “Health for All” by the year 2000.

    1978 3,000 delegates from 134 governments and 67 global organizations participate in the Alma-Ata conference, which was sponsored by the WHO and UNICEF, promoting primary healthcare as the ideal model.

    1985 The Rockefeller Foundation hosts the Good Health at Low Cost Conference.

    1997 The British government releases the Acheson Report, which recommends considering the impact on health equity of all government policies.

    1990s Efforts are made worldwide to improve maternal and pediatric health and combat HIV/AIDS rates by focusing on preventive care and education.

    2002 Sweden creates a national strategy that sets public health objectives that take into account a person's ability to thrive economically. Even today, it's considered the most comprehensive national policy on social determinants of health.

    2010 HHS launches Healthy People 2020, a 10-year agenda for improving the nation's health.

    2010 Congress passes the Patient Protection and Affordable Care Act to promote overall public health, recognizing the health disparities associated with people not having health coverage due to low incomes and/or pre-existing medical conditions. The law established a $10 billion Prevention and Public Health Fund to expand national investments in prevention and public health and improve health outcomes.

    2015 Prominent economists Anne Case and Angus Deaton publish the paper “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century,” which highlights the rising all-cause mortality rate among middle-aged white Americans in the previous decade.

    Today, fee-for-service remains healthcare's Achilles' heel, slowing the move to value-based care and preventing it from achieving the Triple Aim.

    “The reality is that today, most hospitals are still getting most of their revenue from fee-for-service medicine,” said Anne Weiss, managing director at the Robert Wood Johnson Foundation. “So, I don't think that we can sit back and be complacent and say the transition from volume to value is going to address everyone's social needs. But I do think it's one reason why the topic has gotten more attention.”

    The U.S. also has increasingly faced scrutiny for spending more on healthcare than other countries while delivering less than ideal outcomes.

    A 2017 Commonwealth Fund report found that compared with 11 other nations including the United Kingdom, Australia and the Netherlands, the U.S. fell last in terms of efficiency, access, equity and health outcomes.

    The U.S. also spends less on social services than other developed nations. The Organisation for Economic Co-operation and Development shows that the U.S. spends the largest share of its gross domestic product on healthcare, at 17%, while ranking 23rd out of 34 nations in terms of social service spending.

    “What we're really recognizing is that ZIP code is more important than your genetic code,” said Dr. David Friend, chief transformation officer and managing director of the Center for Healthcare Excellence & Innovation at global financial advisory services firm BDO.

    The right approach

    Stacy Ignoffo, program manager of Sinai Health System's Urban Health Institute (Bill Healy)

    Stacy Ignoffo is program manager of Sinai's Urban Health Institute. That organization for the past 11 years has sent community health workers to patients' homes for a one-on-one approach. In 2011, the program began including asthma patients. In its first year, the program reduced ED visits from asthma by 73% and decreased hospitalizations by 75% for a cost savings of $8 for every $3 spent.

    It's an admirable effort on a small scale, but the ultimate goal of social programs is to reform healthcare into well care that changes both the health and economic outlooks of an entire community for generations to come. That's not a small or easy task.

    Understanding that they can't do it alone, providers have looked to community and municipal partners to make a more lasting impact that may require less direct investment.

    Kaiser Permanente, for example, has engaged government agencies to create policies aimed at improving public health.

    “We're absolutely thinking about the upstream interventions that we need to do with our community partners to see what really is impacting the fabric of our communities—things that impact poverty and race inequities,” said Dr. Bechara Choucair, Kaiser's senior vice president and chief community health officer.

    The Oakland, Calif.-based integrated system also has invested $200 million to fight homelessness and housing instability through its Thriving Communities Fund.

    Choucair said the work Kaiser has done with cities has led to the creation of policies that address healthy eating, active living and early childhood education. Kaiser also is the only healthcare provider member of the Billion Dollar Roundtable, a consortium of large companies that each spend a minimum of $1 billion every year supporting minority- and women-owned firms.

    Other systems, such as ProMedica, based in northwest Ohio, have focused on solving food insecurity by working to revitalize local communities. The system in 2015 co-founded the Root Cause Coalition, a not-for-profit collaborative of health systems, insurers and advocacy organizations dedicated to addressing the causes of health inequity.

    Such lobbying efforts on the part of health systems have led to higher taxes on sugar-sweetened beverages and cigarettes, cities working to promote walking and bicycling, and interventions to reduce violence.

    In still another unique example, the Cleveland Clinic recently handed over its laundry business to the Evergreen Cooperative, which builds community wealth by allowing employees to share business ownership in historically impoverished areas. The move created 100 local jobs.

    “We see this as an important step we can take to support the health and well-being of our neighbors,” said Ralph Turner, executive director of patient support services at the Cleveland Clinic.

    The city of Cleveland exemplifies how wealth can impact health. The median household income in the inner-city neighborhood of Hough is $18,500, while eight miles east in the more affluent suburb of Lyndhurst, the median is $63,000. Hough is 98% African-American and the average male life expectancy is 64 years. In Lyndhurst, which is 86% white, men can expect to live up to 88 years.

    Leveraging purchasing power

    The Democracy Collaborative is a community development organization that helped start the Evergreen project and has in recent years set its sights on the healthcare industry as a willing and capable sector of the economy to tap for investment opportunities. The group even published a paper, titled Can Hospitals Heal America's Communities?

    David Zuckerman, director for healthcare engagement at the collaborative, said initiatives like Evergreen show how providers can more effectively address social needs by leveraging their enormous purchasing power to help combat poverty.

    “It's a tremendous way of illustrating that you can as a health system, in an era of tight margins, get the quality and price that you need while also having this tremendous social impact in the neighborhoods in a way that will really be a game-changer,” Zuckerman said.

    Evolent's Cattrell said the healthcare industry needs to see investments in social determinants as not just a financial benefit but as a public good shared by all.

    “Right now, ROI is almost all monetary,” Cattrell said. “When you think about providing some of those larger initiatives like supportive housing or legal assistance, they have a much broader effect beyond just healthcare costs—there's not a good framework yet to really think about it more holistically.”

    Unlike other developed countries with more robust social safety nets, healthcare providers in the U.S. are stepping in to find the right supports to address patients' social needs, and in some cases, they must provide those supports themselves. Yet the majority of providers and payers have made small investments. For not-for-profit hospitals, much of that investment has been tied to community benefit requirements to maintain their tax-exempt status.

    The hospital's role

    A 2017 survey by the Deloitte Center for Health Solutions of 300 hospitals and health systems found the vast majority, 88%, were committed to addressing social determinants and were screening patients for social needs. The survey also found 72% of hospitals had not made any investments. Nearly 40% of hospitals surveyed said they were not measuring the outcomes of their initiatives. Most systems have limited their activities to target a small subset of their patient populations, such as high utilizers, or those who are at risk of becoming frequent ED visitors.

    Many initiatives going on today serve as “pilot projects.”

    “The reality is that this is a field that needs to continue to be built and a field that needs to continue to grow,” Choucair said.

    In addition to its policy work, Kaiser has invested in ways to benchmark and improve its social programs. Last year, Kaiser launched the Social Needs Network for Evaluation and Translation, known as Sonnet, which evaluates the success of the system's social interventions. Kaiser also partnered with the Robert Wood Johnson Foundation to create the Social Intervention Research and Evaluations Network, or SIREN, with the goal of building consensus on common measures and methods to address social determinants of health.

    Such tools have been used over the past two years to address how well Kaiser identifies and then addresses food insecurity among members. Sonnet surveyed Kaiser Medicare Advantage plan members in Colorado and found many members were food-insecure, yet the majority of that age group had not been screened. The research also found a lot of those members may have been slipping through the cracks because those patients did not have a higher rate of utilization than members who were not food-insecure, which indicated a need for broader screening.

    Those findings helped Kaiser employ the screening tool Your Current Life Situation, a survey used in Kaiser's primary-care and emergency department settings. Within the health system's Northwest region, survey responses are included in patients' electronic health records, which are then used by a patient navigator to help them find community resources to meet their social needs.

    Independent research points to an economic rationale for addressing social needs. For example, homelessness is tied to greater use of emergency care. A recent examination of the economic impact of medical respite programs, which provide temporary medical care for homeless persons who don't need to be admitted to a hospital, found the programs reduced ED visits by 45% and readmissions by 35% for a savings of $1.81 for every dollar spent.

    “We see more economic return in providing our services than maybe some folks who don't have the same mission that we have,” said Ruth Krystopolski, senior vice president of population health for Charlotte, N.C.-based Atrium Health. The system spent $306 million in 2017 on uninsured care as a safety-net provider, a figure that Krystopolski said pushes the system to find ways to reduce costs.

    In 2015, Atrium began collecting demographic data from various sources including local universities and public health departments with a goal of identifying, cataloging and documenting patient social determinant information to then connect them with community supports.

    Atrium's recent pilot project involves screening food insecurity among senior patients at highest risk for readmissions. The system then provides emergency food services and helps them complete SNAP applications. So far, Atrium has reduced readmissions 60% in this group.

    But not everyone sees the value of these efforts.

    Consultancy Leavitt Partners in May published a survey of 600 physicians that found the majority believed fixing inequality in income, transportation, food access and housing did benefit patients' health, but they didn't think it was their responsibility to fix those issues. “I don't think systems have adopted this en masse, but I think there has been an uptick, and that it has been driven by an increasing sense of the economics,” said David Smith, co-founder of Health Care Council of Chicago, a collaborative of Chicago healthcare businesses to address health disparities.

    The road ahead

    Sinai's Ignoffo has not found sustainable funding to meet the upfront costs involved in running the community health worker program. It's currently funded through public and private grants.

    The lack of payment from private or public payers for those services is a challenge. “There's a little bit of money out there for providers, but it's not significant and there's also not a lot of infrastructure,” said Dr. Gail Cunningham, senior vice president and chief medical officer at the University of Maryland St. Joseph Medical Center.

    Mount Sinai HospitalSinai has not found sustainable funding to meet the upfront costs involved in running its community health worker program. It's currently funded through public and private grants. (Bill Healy)

    The University of Maryland uses community health workers to address social ills so discharged patients won't return to the hospital. The program has reduced readmissions by 65% among at-risk patents living at home.

    But Maryland's payer system is unique in that hospitals in the state every year receive a fixed amount to care for patients. That motivates them to reduce unnecessary utilization.

    “In other markets where every case you see you bring in more money, it may not make as much sense unless there are other pressures, rewards or penalties within in the state to drive change behavior,” Cunningham said.

    Cattrell said as hospitals and health systems take on more risks and develop their own insurance plans, the incentive to provide care in the most cost-effective and potent manner will only continue to underscore the importance of social determinants.

    “The idea and the transformation of late is how do we integrate social determinants in a way that is not something that is just being done to the patient off to the side but is truly part of their care plan,” Cattrell said. “I think the perception of what a social need is and how it relates to the broader person is where the real transformation is happening.”

    Related Stories

    Financial imperative: Payers can't control costs without addressing social determinants
    The one-stop shop: How OhioHealth provides fresh food to address diabetes

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Wyo. hospital offers bonus to healthcare workers willing to get vaccinated before summer
    Wyo. hospital offers bonus to healthcare workers willing to get vaccinated before summer
    Alaska tribal health groups distribute vaccine far and wide
    Alaska tribal health groups distribute vaccine far and wide
    Sponsored Content
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2021. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Minorities in Healthcare
          • - Luminaries
          • - Top 25 Minority Leaders
          • - Minorities to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Nominate
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Healthcare Transformation Summit
        • Leadership Symposium
        • Virtual Briefings
          • - Hospital of the Future
          • - Mental Health
          • - Patient Safety & Quality
          • - Strategic Marketing
          • - Virtual Health
          • - Workplace of the Future
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Minority Leaders Gala
        • Top 25 Women Leaders Gala
      • Webinars
      • COVID-19 Event Tracker
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing