For providers like Cleveland-based MetroHealth, developing strategies to address social determinants was a necessity as a part of their business model well before the current trend. In 2009, the system launched its patient-centered medical home for all of its primary-care services with a goal of mitigating social needs to improve the outcomes of its medically and economically vulnerable patient population.
MetroHealth CEO Dr. Akram Boutros said in the past couple of years he’s been approached with several proposals from vendors offering population health solutions. But he discovered the system’s own initiatives were more advanced in such initiatives—as its utilization of electronic health records to identify those with social needs, the development of risk stratification programs, and the assessment of social needs to help in the creation of its assistance programs.
In June, the system announced plans to invest $60 million toward providing housing, job training and other social services to the community and provide up to 250 new apartments to residents as part of its effort to address social needs.
Boutros said the health system has experimented with a number of initiatives with varying degrees of success over the years. But he said that approach has been beneficial to identifying what has been effective.
“We call it failing effectively,” Boutros said. “We fail small, we fail fast, and we fail forward so that we’re constantly putting programs in place, seeing if they are making a difference, fine-tuning them, and constantly learning from them.”
Similarly, Drew Crenshaw, chief population health officer at Oak Street Health, a community-based primary-care provider for Medicare patients headquartered in Chicago, said conducting robust pilot projects was an important step in working out problems and finding effective solutions.
Oak Street has developed such tools as a decision-support system called Canopy that has been used to obtain more detailed information on each patient and to track their care from hospital discharge to home. The system helped to reduce 30-day patient readmissions by 15% in 2017, but Crenshaw acknowledged that identifying population health strategies that work and can be scalable throughout its growing network has become a challenge.
“As you grow, you don’t have the luxury of shooting from the hip,” Crenshaw said. “You need to incubate things smartly before you go full scale.”