{"id":24880,"date":"2019-06-28T16:50:31","date_gmt":"2019-06-28T16:50:31","guid":{"rendered":"https:\/\/www.tmc.edu\/news\/2019\/06\/why-hospitals-are-investing-in-health-care-upstream\/"},"modified":"2019-08-28T16:10:48","modified_gmt":"2019-08-28T16:10:48","slug":"why-hospitals-are-investing-in-health-care-upstream","status":"publish","type":"post","link":"https:\/\/www.tmc.edu\/news\/2019\/06\/why-hospitals-are-investing-in-health-care-upstream\/","title":{"rendered":"Why hospitals are investing in health care upstream"},"content":{"rendered":"

Julia Andrieni, M.D.,<\/a> recalled a patient who recently made repeated visits to a Houston Methodist Hospital emergency room. He didn\u2019t have any acute medical condition\u2014he was just looking for some food. But the repeat visits cost the hospital money and didn\u2019t do much to help the patient, either.<\/p>\n

A Houston Methodist<\/a> caseworker, Andrieni said, did some digging. It turned out the patient was suffering from dementia and living in his car. His son, who lived in another state, was unaware of this until Houston Methodist contacted him. The caseworker was able to work with the family to help the patient move in with his son and reduce the unnecessary hospital visits.<\/p>\n

This story illustrates a new approach to care in hospitals in Houston and beyond, said Andrieni, president and CEO of Houston Methodist Coordinated Care. \u201cFor this program to work, we have to provide care not just inside our walls, but outside our walls,\u201d she said.<\/p>\n

Today, many United States hospitals are assuming responsibilities traditionally held by social service agencies. It\u2019s a role they weren\u2019t necessarily designed to take on, but may be well-suited to, given their access to vast volumes of data, their trusted role in the community and recent policy changes.<\/p>\n

New paradigm<\/h4>\n

In some cases, examples of the new paradigm are relatively straightforward, such as connecting patients with social workers or referring patients to Federally Qualified Health Centers (FQHCs) that can meet their primary care needs. In other cases, they\u2019re more complex and creative, and suggest a broader rethinking of what, exactly, it means to provide health care.<\/p>\n

A hospital based in Columbus, Ohio, for example, is offering grants for housing repairs to 150 homeowners nearby. In Chicago, a health system sends community workers to asthmatic patients\u2019 homes to show how dust and secondhand smoke can exacerbate their conditions. In Boston, a health care provider placed tax preparers in its pediatrics department to help families get proper tax credits and full tax refunds.<\/p>\n

This broadening of responsibilities is what health experts call investing in health care \u201cupstream,\u201d said Chris Greeley, M.D.<\/a>, chief of public health pediatrics at Texas Children\u2019s Hospital and vice chair of community health at Baylor College of Medicine<\/a>. \u201cYou have to pay attention to the context in which people are living,\u201d he said.<\/p>\n

Public health experts agree that, for the most part, about 80 percent of our health is related to things that occur outside of the health care system. Europe and the United Kingdom have long appreciated the link between social investment and health, and have found success funding the former to help achieve savings on the latter. But over the last decade, the U.S. has increasingly come around, too, Greeley said. Health care providers are recognizing that it is ineffective and inefficient to treat patients and then send them right back to the very conditions that contributed to their illnesses or ailments. In recent years, providers have moved beyond studying the links between social conditions and health and are launching programs to address the link.<\/p>\n

When U.S. Secretary of Health and Human Services Alex Azar<\/a> last year spoke about the issue, he teased the idea of moving health care toward \u201csolutions for the whole person.\u201d Beginning in 2020, Azar said, Medicare Advantage plans\u2014 which pay for managed care based on a monthly fee per enrollee\u2014could start paying for benefits like home modifications, home-delivered meals and more. The idea is to keep seniors out of the hospital if they don\u2019t need to be, saving money and improving their health.<\/p>\n

\u201cIt\u2019s not new, and it\u2019s not rocket science\u2014social workers have been doing this stuff for 100 years,\u201d said Len Nichols, Ph.D.<\/a>, director of the Center for Health Policy Research and Ethics at George Mason University. But several factors are driving hospitals to embrace a broader function, he explained.<\/p>\n

Part of the solution<\/h4>\n

First, as a result of the Affordable Care Act (ACA), hospitals can be penalized when patients are readmitted after undergoing medical treatment. That gives health care providers a strong incentive to address upstream issues that can help prevent readmission\u2014or hospitalization in the first place.<\/p>\n

\u201cThe best way to avoid a hospital readmission is to avoid an unnecessary admission,\u201d said Bita Kash, Ph.D.<\/a>, director of the Center for Outcomes Research at Houston Methodist.<\/p>\n

Second, the ACA created systems by which hospitals could sometimes keep a portion of the savings if they avoided unnecessary costs. In some cases, hospitals themselves function as the health insurer, so they may have an incentive to avoid unnecessary, expensive care and invest \u201cupstream\u201d if it can help achieve savings.<\/p>\n

The reshuffling of duties raises fundamental questions about the role and responsibility of major institutions in society. Who is responsible for ensuring patients have safe living conditions? Who\u2019s responsible for making sure they have access to healthy food? Doctors and hospitals, Greeley said, aren\u2019t usually the solution to these types of broader societal questions\u2014but almost all of the time, they\u2019re part of the solution.<\/p>\n

\u201cIf [your patient] is talking to you about how their car just got repossessed, and our response is \u2018good luck with that,\u2019 that seems like an opportunity that\u2019s been missed,\u201d Greeley said.<\/p>\n

At Houston Methodist, the health system manages 30,000 Medicare patients in the Houston area through its Houston Methodist Coordinated Care ACO. (Accountable care organizations are groups of health care providers who work together to offer coordinated care.) Historically, Methodist has provided grants to FQHCs and mental health providers as a community benefit. Now, as an ACO, the hospital is also involved in more targeted, value-based care.<\/p>\n

This means Houston Methodist is linking patients with social workers and case managers, who can help connect patients with social services. It is training clinicians to embrace a holistic view of health. The system is also using predictive analytics to identify patients who are most likely to benefit from early interventions so they can be reached \u201cbefore they fall off the cliff,\u201d Andrieni said.<\/p>\n

For example, Houston Methodist purchases food through Meals on Wheels for patients who won\u2019t be able to shop for or prepare food after a hospital discharge, and it hopes to integrate a software service called \u201cAunt Bertha\u201d that connects patients to food, housing and transportation providers via its Epic electronic health records system.<\/p>\n

In a similar vein, Memorial Hermann Health System<\/a> officials recently unveiled a new service center at Memorial Hermann Southwest Hospital in Sharpstown, where health navigators can connect patients to legal aid organizations, homeless shelters, FQHCs and other services. Their goal is to work with patients before they\u2019re in a crisis, said Carol Paret<\/a>, CEO of Memorial Hermann Community Benefit Corporation. The resource center is open to anyone, not just patients.<\/p>\n

Memorial Hermann has enrolled about 100 patients in its own program that provides six weeks of Meals on Wheels services after hospital discharge. That program, Paret noted, has the added benefit of putting extra eyes on the patient. If drivers see a patient is struggling, they can suggest that a Memorial Hermann caseworker follow up.<\/p>\n

This is part of a broader effort to use trained \u201cnavigators\u201d to screen Memorial Hermann patients for food insecurity. The system\u2019s ultimate goal is to determine whether all patients\u2014 regardless of how they\u2019ve entered the Memorial Hermann system\u2014have reliable access to healthy food. Trained \u201cnavigators\u201d started screening patients for food security more than a year ago. Now, the questions are built into patients\u2019 electronic health records and physicians are getting training in how to pay attention to the responses.<\/p>\n

\u201cWhat I tell doctors, all the time, is that if your patient is food insecure, they\u2019re not going to follow the diet and they\u2019re not going to fill the prescription,\u201d Paret said. Hospitals must recognize the importance of conditions beyond their walls. \u201cThe reality is, hospitals can\u2019t do it all,\u201d Paret said. \u201cBut hospitals are a piece of the solution.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Julia Andrieni, M.D., recalled a patient who recently made repeated visits to a Houston Methodist Hospital emergency room. He didn\u2019t have any acute medical condition\u2014he was just looking for some food. But the repeat visits cost the hospital money and didn\u2019t do much to help the patient, either. A Houston Methodist caseworker, Andrieni said, did […]<\/p>\n","protected":false},"author":24,"featured_media":24881,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":""},"categories":[1],"tags":[63,1211,3877],"yoast_head":"\nWhy hospitals are investing in health care upstream - TMC News<\/title>\n<meta name=\"description\" content=\"It\u2019s a role they weren\u2019t necessarily designed to take on, but may be well-suited to, given their access to vast volumes of data, their trusted role in the community and recent policy changes.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.tmc.edu\/news\/2019\/06\/why-hospitals-are-investing-in-health-care-upstream\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Why hospitals are investing in health care upstream - 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