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As 2020 Nears, Addressing Needs Beyond Clinic Walls Rises on the Healthcare Radar

Mary Caffrey
As they take on risk, health systems have to address factors that contribute to rising rates of obesity, diabetes, or dementia-and they are doing so in novel ways.
So much of healthcare happens beyond the walls of the clinic; health systems taking on risk—or just trying to do better for their patients—have little choice but to think about the social and behavioral problems that translate into higher rates of diabetes, obesity, or dementia.

These 3 costly conditions that already drive public healthcare spending—diabetes alone accounts for $1 of every $3 spent in Medicare—are projected to drive more as the population ages.

Different thinking about the “social determinants of health” is changing the role of health systems, according the panel in the Healthcare 2020 Series, a forward-thinking discussion that concluded the spring meeting of the ACO & Emerging Healthcare Delivery Coalition®, which took place May 4-5, 2017, in Scottsdale, Arizona. The coalition is an initiative of The American Journal of Managed Care®.

Moderated by Clifford Goodman, PhD, of The Lewin Group, the discussion featured Michael Griffin, MS, CEO of the Daughters of Charity Services of New Orleans; Jonathan Hirsch, MSci, founder and president of the precision medicine company Syapse; and Sachin Jain, MD, MBA, FACP, CEO of CareMore, a subsidiary of Anthem that delivers integrated care to Medicare and Medicaid patients.

Griffin started by explaining the health, educational, and economic conditions for his patients post-Katrina: the city’s devastation provided a once-in-a-century opportunity to remake the healthcare system, with a $100 million grant to create a system of primary healthcare centers to replace Charity Hospital, which had served New Orleans’ poor for generations. Electronic paper records replaced the paper files destroyed in the storm.

What’s much harder to replace, however, is intergenerational poverty, a culture that values living hard and eating well, and health and financial illiteracy that would make managing a health savings account (HSA) problematic for many.

In the past year, Griffin said, the launch of Medicaid exchange has been a game changer—enrollment statewide is already at 432,000, well ahead of the projected 375,000 for the first year. But Griffin said he’s struggling to replace the value-based payment systems introduced after Katrina under the grant, as he works one by one with Louisiana’s 5 managed care organizations (MCOs) to create per member, per month payment models. (He’s succeeded with 2 MCOs.)

There’s good news, however. “We’ve seen an increase in utilization of preventive services, focused through a private system managed for the public benefit,” Griffin said. By historic standards, this a revolutionary for Louisiana; for decades the poor received all their primary and acute care in a hospital, or “cattle call” setting, as Griffin put it, and these habits are hard to break. The use of electronic health recor and modern communications means Daughters of Charity can find out in real time when one of its patients visits the emergency department for a non-emergency and try to direct them to a clinic instead.

Similarly, Jain said CareMore uses neighborhood-based centers that feature specialized programs in diabetes, innovative solutions like managing chronic disease in the dental setting, and a new program it is launching this week to address loneliness in seniors, which is a leading contributor to poor outcomes. CareMore uses tools like senior-focused gyms and improved transportation.

“Because we are fully at risk,” he said, it costs less to offer these services on an outpatient basis than to admit someone on an inpatient basis.

“In the event they are admitted, we view most hospitalizations as a failure of the healthcare system,” Jain said.

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