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Health Sector Revolution: Changing What Counts as Healthcare

June 28, 2016

By Rebecca Onie - Health Leads

Today, the US healthcare sector is no longer debating the connection between patients’ unmet social needs—like shelter, heat, employment, and food—and poor health. It’s widely recognized that just 10 percent of health outcomes are attributable to medical care, while 20 percent are tied to genetics and up to 70 percent are tied to social, environmental, and behavioral factors: everything that happens in people’s lives when they are not in the hospital or at the doctor’s office.

In partnership with leading healthcare institutions and with investment from the Skoll Foundation, Health Leads has proved that healthcare providers can do something about those unmet resource needs—with real, quantifiable results.

For 20 years, we’ve armed providers with tools, training, and data that empower clinicians to connect patients directly with the community resources they need to be healthy: heat for their homes, transportation to and from doctor appointments, or food after their paycheck runs out. We know these resource connections work. For example, a 2015 Massachusetts General Hospital study affirmed that addressing patients’ unmet social needs, through Health Leads, was associated with clinically meaningful improvements in patients’ LDL cholesterol and blood pressure—the latter at a level greater than the threshold the FDA sets for a new drug.

Our vision, however, is not rooted in more Health Leads, but in accelerating a revolution in the healthcare sector. We envision a health system that addresses all patients’ basic resource needs as a standard part of quality care. We want to change what “counts” as healthcare so that the sector—which currently accounts for 17 percent of the US gross domestic product—actually delivers health, rather than simply treats or manages disease.

Going big with social needs interventions

To fundamentally change a system as complex as healthcare requires leaders with the vision, courage, and will to reject this narrow focus on disease and embrace the responsibility of enabling health. We enlist healthcare leaders with the conviction to take on addressing social needs as a standard of care and to advocate for the broad adoption of this approach throughout the healthcare sector.

Contra Costa Health Services (CCHS)—a public hospital system serving patients in northern California—is just that kind of bold partner. CCHS’s evolution to addressing patients’ social needs began with a survey a few years ago, given to a subset of patients in order to learn more about their most pressing health problems.

CCHS patients listed issues like food, housing, and paying the electricity bill as their biggest health concerns. Nearly two-thirds of patients said they worried about getting enough to eat.

CCHS leadership viewed these unmet resource needs as a critical health problem and took action to address the needs of its population. In 2013, we launched a partnership, working with patients in CCHS’s West County Health Clinic. Since that time, Health Leads has served more than 1,500 patients and demonstrated that clinical integration of this work is possible, effective, and can be truly life-changing for patients and for providers.

Now CCHS has an audacious plan: to scale this approach to care and be the first county-wide healthcare system in the US to tackle the unmet social needs of patients throughout an entire county.

An unprecedented set of key health sector actors is coalescing around this goal. For the first time, a healthcare delivery organization, that organization’s health plan, and public health officials are co-creating a unified strategy to empower every patient to access the resources they need to be healthy. Health Leads’ vision is becoming a reality in Contra Costa County.

Mobilizing health systems leadership

In November 2015, with the Skoll Foundation’s support, we convened senior leaders from 15 major healthcare institutions, collectively serving millions of patients across the country.

Drawing on fellow Skoll awardee Healthcare Without Harm’s powerful collective action “playbook” in promoting ecological sustainability in the health sector, Health Leads challenged this group of leaders to develop a shared vision for the sector and the role it needs to play in delivering health. And they did.

In a matter of hours, they articulated and pledged to lead towards a powerful goal: “In partnership with communities, healthcare organizations will identify and address patients’ most pressing basic human needs as a standard part of quality care.”

They then went on to define the key roles and activities necessary to fulfill this responsibility—and further, committed to pursuing this work at their own institutions and to mobilizing the broader sector. This collective of healthcare leaders is now hammering out guidance to their peers on the “how” of addressing social needs in a high-quality, data-driven way—a first for US healthcare and evidence of true collective impact at work.

Aligning industry incentives

As Health Leads works to accelerate the adoption of social needs interventions, the US government is paying attention—and beginning to signal that the boundaries of healthcare are indeed shifting.

On January 5, 2016, the US Centers for Medicare and Medicaid Services (CMS)—the largest single purchaser of healthcare in the world—announced a five-year, $157 million Accountable Health Communities (AHC) pilot program that “addresses a critical gap between clinical care and community services…by testing whether systematically identifying and addressing the health-related social needs of beneficiaries impacts total healthcare costs, improves health, and quality of care.” CMS itself is calling the AHC pilot “historic”—the first time it has acknowledged patients’ social needs as part of healthcare delivery.

Shortly thereafter, in April, CMS launched its Comprehensive Primary Care Plus initiative, which also recognizes, funds, and studies the impact of social needs interventions in primary care practices.

Through these dual pilots, CMS has at last recognized a broader and more realistic view of what falls within the boundaries of healthcare. This has laid the groundwork for far greater impact on federal health policy and payment decisions that could accelerate us towards Health Leads’ vision of a more just and rational healthcare system, designed around what people need to be truly healthy.

With the tools, leadership, and incentives in place, the time to transform the health sector is now.

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