Nurturing Change in Community Health

As hospitals move toward taking responsibility for the health of those outside their walls, the role of community care resources will grow – but only as quickly as the resources that feed them.

The quality of a community’s healthcare, going forward, won’t be minimally defined by only the tertiary or quaternary care provider’s performance. In communities where “population health” is a goal, quality will also be determined by the effectiveness of dietary and lifestyle counseling, addiction prevention and treatment, and social wellbeing programs that, together, prevent expensive hospital visits down the line. Access to healthful foods and safe housing at affordable prices along with support systems to ensure clinical compliance will increasingly fall onto the continuum of care.

Ideally, healthcare providers will collaborate with their community leaders and service organizations to support this more rounded care approach. Care providers, for the most part, still lack the financial incentives to analyze service gaps, create new services and coordinate them, but this will be changing with the growth in value-based reimbursements. Where progress is already being made, it is most commonly being encouraged by large organizations pursuing population health management initiatives, by external financial incentives, or by select clinicians who desire to provide a more holistic approach to healthcare even though they are not yet being financially rewarded for the comprehensive services.

Self-nurtured vs. Externally Engineered Progress

The first steps toward community care integration are being taken by leading care providers in two situations:
  1. A larger system has advanced far enough in value-based care initiatives that the cost savings of wellness and chronic care coordination programs may outweigh the investment.
  2. The state is incentivizing community care coordination and providing financial resources to pursue it.
The former are still rare flowers, but in states where value-based payments are taking root, care providers may indeed see enough financial reasons to make investments themselves, tapping into a foundation or other pool of funds in support of population health efforts. Others more advanced in their pursuit of population health are undertaking analyses to determine the cost-effectiveness of per-patient fees for health coach and care navigator services, which can generate revenue and prevent hospitalizations – but again, these are still rare cases.

As to the latter, New York, California, Texas, Kansas, Massachusetts, New Jersey and Illinois have begun incentivizing community coordination – admittedly, on a small scale – with their Medicaid waiver programs. The Delivery System Reform Incentive Payment Program (DSRIP) model, rather than focusing on general wellness, is more about managing chronic diseases and coordinating behavioral healthcare in more appropriate community settings to keep these patients out of emergency departments and hospital beds. New York, for example, is providing grant money to identify the highest utilizers of care, target them with new types of care coordination and services, and build the programming required to nurture healthy behavioral changes so that they firmly take root.

At BDO, we’re helping hospitals with wholesale workforce planning efforts that increase the emphasis on care coordination and management in the community. These efforts are facilitated by an increase in health coaches, patient care navigators and similar roles. Such practitioners might have a social work background or some clinical experience, but they do not require clinical licensure nor do they require a thorough clinical understanding to impact the community’s overall wellbeing. What they do require is an understanding of community resources – where can people go for the basic services that they need? Overall, these community outreach efforts are slowly putting a greater emphasis on not just medical care, but a more holistic health and well-being approach.

It Takes Two to Pollinate New Change

Every medical complaint is minor, the adage says, unless it’s one’s own: Individuals experiencing chronic shortness of breath don’t want to be screened for anemia by a dietician; they want a cardiologist to treat them for the heart condition they fear.

Community care provides greater efficiencies. But with it will come the need for community education – a reframing of what it means to “go to the doctor” that will remind some of the primary care provider-as-gatekeeper models of the 1990s.

Even as the shift to a value-based paradigm progresses, care providers will face another paradigm shift toward acceptance of preventive health and lower-acuity treatment models.

The steps right now are small, and the effort to take them is large. But the outcomes will be worth it.