Health Leads expands movement to place social needs at the center of preventive care

At TEDMED 2012, Rebecca Onie asked a simple question with an extremely complex answer:

Why don’t we have a health care system that keeps us healthy?

As a college sophomore, Onie realized through her work as a legal aid intern that lack of basic needs like food, heat, transportation, and health insurance were preventing people from achieving – and, more importantly, maintaining – good health. And she found that most often, doctors practiced a “don’t ask, don’t tell” policy around these issues, assuming, though not without anguish, that these solutions were simply out of reach.

In 1996, Onie co-founded Health Leads, an organization that enables clinicians to “prescribe” food, heat, and other basic resources their patients need to be healthy, alongside medical care.  And what began as a student-run organization in a pediatric waiting room is now national in scale.  In 2014, nearly 1,000 student Advocates will connect over 14,000 patients and their families to the resources they need to be healthy.

In the last two years, Health Leads has received over 1,000 requests for expansion from hospitals, providers, health systems, and others looking for a way to address their patients’ non-medical needs.  On our blog in September, Onie called this demand “symbolic of a much larger shift taking place in the healthcare system.”

And this demand comes from a healthcare system ready for a change.  As Onie reported on Forbes.com after her trip to the 2014 World’s Economic Forum’s Annual Meeting in Davos, the sector is finally asking not whether it is necessary to address patients’ social needs, but how to do so effectively:

This momentum extends beyond the handful of health systems whose vision and values tie explicitly to a comprehensive definition of health….Each of these signals the unprecedented moment unfolding in the U.S. healthcare system, triggered by shifting market trends and financial incentives.

Recently, Health Leads received a $16 million grant from the Robert Wood Johnson Foundation (RWJF) to scale its impact.  The grant represents the largest in Health Leads history and one of the largest ever awarded by RWJF.

The grant will enable Health Leads to serve more patients around the country, as well as help facilitate its next phase of growth – building a national movement to catalyze the healthcare system to address patients’ basic needs as a standard part of care.  In a new article on Stanford Social Innovation Review (SSIR), Health Leads outlines its innovative approach to scale, intending to partner with a small number of leading health systems to drive the change it seeks in the healthcare system:

“Growing in this way enables us to focus on deep integration with our partners, and frees up valuable resources and management time to focus on catalyzing the ecosystem surrounding those partners.”

One of the first new partners in this phase of Health Leads growth: Massachusetts General Hospital (MGH).  Last October, Health Leads opened a desk at MGH that has already served hundreds of patients. And most recently, the organization has expanded west.  At the end of May, Health Leads launched two new sites in California’s Bay Area – one at Contra Costa Regional Medical Center and the other at Kaiser Permanente Medical Center – Richmond.  It is partnerships like these that Health Leads believe will drive the sector to the “new normal” it envisions.  As Health Leads said in SSIR:

Going small may not be glamorous. But if we can couple a powerful on-the-ground demonstration with pathways to change the sector, we will have the opportunity at last to transform health care for patients, physicians, and us all.

Where Health Begins: Lessons from TEDMED’s Great Challenges

Reprinted with permission from HealthLeadsUSA.org.

On September 12th, Health Leads Chief of Staff Sonia Sarkar took part in the TEDMED Great Challenges Google Hangout, “Where Health Begins,” to discuss the role social determinants play in patients’ health.  Special guest Mindy McGrath, Director of Government Relations at the Association of Academic Health Centers (AAHC), kicked off the discussion by sharing the AAHC’s new online social determinants of health toolkit for clinicians, patients, and community members to access best practices for addressing the social determinants of health.  Here are some of our key takeaways from the discussion:

  • The primary access point of care should be within the doctor’s office. While key contributors to health exist outside the doctor’s office, the clinic can still be the place where patients connect to the resources they need to be healthy.  As Sonia pointed out during the discussion, the doctor’s office can effectively be the hub for both medical care and social service connections:

What we’ve been focused on at Health Leads is ensuring that patients have access to the information they need to be healthy within the context of the healthcare setting.  What is important about this particular access point of care is that…it enables us to think about the interplay between where patients get access to resources and where they get access to healthcare.  You can bring those two things together, rather than having the two systems remain separate.

  • We must train health professionals for the new 21st century model of healthcare. As more and more institutions seek out ways to address social determinants, future healthcare professionals must be aware of and understand the full set of factors that affect their patients’ health.  Doctors need to have the knowledge and resources they need to have these tough conversations with patients.
  • We can repurpose the traditional clinic to meet patients’ non-medical needs.  From standard screening paperwork and the prescription pad to electronic medical records, there are a number of tools already in place within healthcare that can be reinvented to address patients’ non-medical needs in conjunction with medical care.

At Health Leads, we are excited to be a part of these important conversations on the social determinants of health.  While we recognize that a number of factors that affect patients’ ability to get and stay healthy exist outside the clinic walls, our vision for healthcare includes the idea that the doctor’s office can be re-imagined to be the place where patients go to address these most basic resource needs.

Watch the TEDMED Great Challenges discussion.  Read more about the Association of Academic Health Centers’ Toolkit.

Panelists included Dr. Bob Atkins, Associate Professor of Nursing at Rutgers University, Dr. Sandeep Kishore, Co-chair of the Young Professionals Chronic Disease Network, Dr. Anne Beal, COO of Patient-Centered Outcomes Research Institute, and Mindy McGrath, Director of Government Relations at the AAHC. The panel was moderated by Amy Lynn Smith, healthcare communications writer and strategist.    

Rebecca Onie: At last, healthcare considering patients’ social needs

By Rebecca Onie

In April of 2012, I had the opportunity to pose a simple question to the TEDMED community:  What if our healthcare system actually kept us healthy?

This is a simple and universally shared aspiration –the idea that our healthcare system could prevent patients from getting sick in the first place, rather than only treating patients after they have fallen ill. But as is so often the case in healthcare, this can feel intractable. Addressing the root causes of poor health –for example, prescribing antibiotics to a pediatric patient only to find out she has no food at home or is living in a car—can feel overly expansive, complicated, and expensive.

At TEDMED 2012, we sought to present a solution that is instead simple, effective, and cost-effective: in the clinics where Health Leads operates, physicians can prescribe healthy food, heat in the winter, and other basic resources patients need to be healthy, alongside prescriptions for medication. Patients then take those prescriptions to our desk in the clinic waiting room, where our corps of well-trained college student Advocates “fill” those prescriptions by working side-by-side with patients to connect them to the existing landscape of community resources.

The response at TEDMED, as well as the continued demand that Health Leads has experienced since then, has been swift and unequivocal: over the past nine months, we have received expansion requests from more than 700 healthcare institutions that are urgently seeking solutions that will address their patients’ true health needs.

This demand is symbolic of a much larger shift taking place within the healthcare market. The next 12 months, as we all know, will be an unprecedented moment of fluidity and possibility in healthcare. More than twenty million previously uninsured people will introduce complex social needs into the Medicaid system – in the face of a 21,000 physician shortage. Healthcare providers, accountable for delivering health outcomes in this challenging landscape, are compelled to pursue new care delivery models that account for the realities of patients’ lives.

A Health Leads advocate at Hasbro Children's Hospital in Providence, Rhode Island meeting with a patient. Credit: Courtesy of Health Leads

A Health Leads advocate at Johns Hopkins Hospital Children’s Center in Baltimore, Maryland meeting with a patient. Credit: Courtesy of Health Leads

 

These providers – like Health Leads partner Nassau University Medical Center (NUMC)– are leading the way in demonstrating that it is indeed possible to address patients’ basic resource needs in a clinical setting. NUMC has fully integrated Health Leads into its pediatric outpatient operations – empowering doctors, nurses, and social workers there to ask their patients: Are you running out of food at the end of month? Are you worried about paying the electrical bill?

If the answer is yes, those same providers can refer any patients in those clinics to Health Leads, just like any subspecialty referral – and our Advocates can provide real-time updates to the rest of the clinic team about whether or not a patient got the needed resource, yielding better informed clinical decisions.

Furthermore, NUMC is just one of many institutions that are acknowledging the economic value of addressing patients’ social needs – two-thirds of Health Leads’ clinical partners cover all or some of the cost of our services.

Shifting market trends in healthcare are providing increasing financial incentives for healthcare institutions to pay for models like Health Leads: for example, to achieve Patient-Centered Medical Home certification, institutions must show that they 1) maintain a current resource list on five topics of key community service areas of importance to the patient population and 2) track referrals to patients/families.

Health Leads fulfills both of these basic requirements and also gives clinicians a fully built-out patient flow that is aligned with the design principles of a medical home: we are physically based in the clinic, available to patients with a referral from their primary care provider, and are incorporated as part of the greater care coordination team.

The healthcare system is moving.  Clinicians are demanding the ability to address all of the factors that prevent their patients from staying healthy. Patients expect to be able to speak with their doctor about the things that are making them sick in the first place –running out of food at the end of the month, or lack of electricity needed to keep their medicine refrigerated. And hospitals are allocating scarce budget dollars to address these needs.

At long last, the healthcare system is grappling with the realities of patients’ lives. If we together act now to adopt  practical, simple solutions that work, we can move at last from imagination to implementation. And we can create a new kind of healthcare – for patients, for doctors, and for all of us.

Rebecca Onie is Co-Founder and CEO of Health Leads. Join a representative from Health Leads and other organizations for TEDMED’s online discussion about the social determinants of health this Thursday at 2 pm ET. Ask questions via Twitter #greatchallenges – we’ll answer as many as we can on air.