By the time a patient is referred to the Greater Flint Health Coalition, a doctor or another health care professional has identified there’s something more than just their physical health that’s endangering the person’s health.
It may be they don’t regularly have access to transportation to get to their medical appointments, or there’s not enough food on their table. Perhaps housing is an issue, or they haven’t been able to find a job.
“In traditional health care systems, we go to the doctor when we’re sick; if we have a chronic condition, we get treatment for that,” said Kirk Smith, president and CEO of the Greater Flint Health Coalition, a nonprofit working to improve the health of Genesee County residents. “But, for me, when we talk about health care, we have to talk about education, employment, quality of housing, the food people have access to — all of those are health issues, too.”
It’s this concept — that health care is about far more than just addressing an immediate physical issue — that is driving a new “health equity project” that the Greater Flint Health Coalition and a wide range of other organizations are partnering on across the state.
Launched with $9 million from the U.S. Centers for Medicare and Medicaid Services (CMS) and $1 million from Michigan Medicine, the project initially aims to improve health care in five Michigan counties — Washtenaw, Genesee, Jackson, Kent and Livingston — by taking a more holistic approach to health. That approach entails physicians and other medical professionals better identifying and collecting data on a patient’s socio-economic challenges — such as a lack of food or not having housing — and being able to immediately connect them with social support services that will address those issues.
Ultimately, project leaders hope to expand the project to all 83 counties in the state.
Terrisca Des Jardins, executive director of the Center for Health and Research Transformation (CHRT), a nonprofit health research and policy center at the University of Michigan, said the project’s goal is to transform the way society has historically separated medical care from social supports in order to achieve better health for residents throughout the state.
For example, she said if someone is struggling with food insecurity, they may be facing a wide range of social challenges that are impacting their health. This new health equity project will lay the groundwork for that individual to provide information about their social challenges to their primary care physician or other doctors.
Instead of a doctor solely giving that individual a prescription for an immediate medical problem they’re facing, they will know the community-based organizations where their patients can go to receive support around these social challenges. Those organizations, like the Greater Flint Health Coalition, will then be able to work with the individuals on a massive array of issues, from securing employment to preventing eviction.
“When I was in my early 20s, one of my first projects when I was working in the state of New Mexico was looking at Medicaid benefits,” Des Jardins said. “We traveled around the state and held focus groups with community members to get input on Medicaid services. In a small, rural community in New Mexico, people didn’t want to talk about health benefits; they wanted to talk about running water and electricity. That was a profound experience for me. Since then, I’ve been wanting to focus on a holistic approach [to health].”
As part of the new health equity project, officials from CHRT will teach medical professionals about health equity and how to incorporate it into their work, said Dr. Michael Englesbe, a professor of surgery at the University of Michigan. Englesbe is the portfolio director of what’s known as the Collaborative Quality Improvement (CQI) initiative, which is a collective of about 20 groups across the state that aim to improve health care through hospitals and physicians collecting, sharing and analyzing data on patient risk factors and outcomes of medical care.
Led by Michigan Medicine and funded by Blue Cross Blue Shield of Michigan, the CQIs are, like CHRT, playing a major role in the new project. Other major players in the project include the Michigan Data Collaborative, a data collection, aggregation and reporting organization at the University of Michigan, and the Michigan Health Information Network, a nonprofit that works to provide patient health information to medical providers.
“We don’t have a lot of information on social issues like food insecurity, poverty — all these things that have a massive impact on people’s health and health care,” Englesbe said, referring to physicians throughout the state. “With this [health equity project], we are setting up an infrastructure so physicians have data on their patients to understand their social determinants of health. When they see patients have challenges around social care, we’ll have an infrastructure set up so doctors know where to send their patients.”
Englesbe noted the health equity project will ensure that patients’ records include information about social determinants of health. That way, when a health care provider pulls up a patient’s chart, they’ll be able to see past challenges with, say, employment or housing and will be able to inquire about and address those issues.
“I’m a liver transplant surgeon, and the answer to better health care is not to do more liver transplants, but make it so we don’t have to do liver transplants at all,” Englesbe said, stressing the importance of medical professionals addressing socio-economic issues as part of their job.
“Let’s talk about all these foundational health problems that the health care system is not suited to take care of,” Englesbe continued.
Smith, of the Greater Flint Health Coalition, explained that connecting disenfranchised patients — individuals who have faced systemic racism in medical care, for example — are far more likely to begin trusting the health care system if it provides both medical and social support.
He noted he has already seen that through the explosion of patients that the Genesee Community Health Access Program (CHAP) provides. CHAP is administered by the Greater Flint Health Coalition; since 2015, it has worked to do something similar to the health equity project by connecting with hospitals, doctors and health plans to provide patients with a range of social support.
“When we started in 2015, our goal was to serve 800 total people a year; we’re now serving 1,500 individuals a month,” Smith said.
With the health equity project, Smith expects that number will continue to grow.
“This is really, really important work,” he said. “It’s one of the most important things we can do. When it comes to what impacts a person’s health or community’s health, so much of that doesn’t happen in the doctor’s office. We need to be able to address food or transportation or housing and the gaps in resources.”
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