Addressing the social determinants of health (SDoH) in communities is a hot topic of conversation in healthcare. The industry has bought into the theory that 20 percent of an individual’s health is determined by clinical care and the rest by social, economic, genetic and behavioral factors. But perhaps more importantly health systems need to recognize that they can’t solve this issue on their own.
From my perspective at PCCI, I’ve seen an increase in value-based contracting models in recent years, and health systems and physicians are looking beyond the four walls of their institutions to build relationships with outpatient, behavioral health, post-acute care, and now non-medical providers. The number and types of collaboratives between health systems and non-traditional providers has been growing over the past several years with a recent report gathering information on more than 200 different partnerships between hospital and community-based organizations across the country.
But while health systems may be embracing community provider relationships, I believe that sustainable success in addressing social determinants of health requires a fundamental shift in the way health systems view their role in improving the health of their communities.
Over the past ten to fifteen years there has been an evolution in how health systems have approached improving health outcomes. Initially health systems focused on providing high-tech solutions for care delivery such as robotic surgery, and advanced imaging techniques. Then to meet the need for increased access and demand for outpatient services, health systems seeded service areas with ambulatory surgery centers, urgent care, retail clinics, and physician offices.
In each of these evolutions the strategies centered on a solution created by the health system alone. And one could argue that the main beneficiaries of these investments were often the health systems themselves – increased market share, improved reimbursements. But such a self-centered approach will not work when addressing social determinants where the root causes lie outside the four walls of the health system.
Effectively creating a system of community will require a collaborative mentality from health systems. While they may have power and influence to gather partners to the table, execution of successful interventions lies with social services and community-based organizations that are the experts in understanding and helping individuals address social needs. Even if not leading, health systems should still be active participants in this work. Indeed, there are areas where their contributions to the organization of partners is critical:
Seeking to recognize a healthcare delivery organization that takes an outstanding and innovative approach to health information management (HIM), the American Health Information Management Association (AHIMA) is calling for applications for the eighth annual Grace Award.
Interested applicants can submit their entries via ahima.org/grace through May 31.
Ninety years ago, Grace Whiting Myers acted on a sincere conviction to improve the quality of our nation’s health records by founding the association now known as AHIMA. The idea was simple–that advancements in the collection and organization of health information will invariably help to improve public health. As a tribute to Myers’ prescient vision, AHIMA’s annual HIM award bears her name: The Grace Award.
Past winners of the Grace Award regularly demonstrated transformative journeys toward new and innovative HIM practices that also delivered better patient outcomes.
Wylecia Wiggs Harris, PhD
“AHIMA is excited to open nominations for an organization that is taking innovative and novel approaches to using HIM to deliver high-quality care to patients,” said AHIMA CEO Wylecia Wiggs Harris, PhD, CAE. “This process furthers an industry dialogue about innovation and excellence and invites us to learn from each other.”
The 2019 award will be presented at AHIMA’s Health Data and Information Conference in Chicago, September 14-18.
A committee of judges, representing healthcare delivery organizations, health information professionals and HIM associations, selects the Grace Award. This year’s judges are:
(CHAIR) Sandra Pearson, RHIA, CHDA, MHA, CPEHR, CDI & Data Governance Director, SCL Health
Guest post by Dr. Jennifer Yugo, chief scientist, Corvirtus.
Jennifer Yugo, PhD, SPHR
This is a time of tremendous growth and change in healthcare. As in any industry, growth sparks competition as patients have more and more providers from which to choose. From the supply side, this means increased competition for new, repeat, and referral patients. Simultaneously, providers are being pressed to reduce costs while improving the patient experience as they compete for market share.
Healthcare is becoming more competitive as patients have more choices and better information about their choices, especially through social media. To compete, providers have to focus on delivering quality service, a compelling patient experience, and – like competitors in retail – generate buzz.
Our research shows that a healthcare provider’s employees are the most significant contributor to delivering quality, being compelling, and generating buzz. The first component of this formula is ensuring you are hiring the right people. These are employees who perform, fit, and stay.
Pre-employment assessments are widely used across other industries as a key ingredient to quality. Healthcare is a final frontier where personality tests can be leveraged to improve individual and team performance, reduce costs, and most importantly, improve and differentiate patient care.
Sadly, healthcare positions are often viewed as “The Untouchables” where intuition and gut-instinct for hiring and management are used over evidence-based best practices. Following our intuition often results in hiring the wrong people – those who do not perform, are difficult to work with, and either quit or get fired.
Turnover is a huge component of costs and an obstacle to improving care, as well as the patient experience. With shortage of 68,000 primary care physicians predicted by 2025, consider the cost of turnover for one physician:
It’s called healthcare for a reason. Technology is a powerful tool, but people are the solution. The Twine Health Collaborative Care Platform allows for the co-creation and tracking of personalized care plans that serve as common ground for continuous collaboration between patients, coaches and their clinicians. Patients get support from their care team, on their terms whenever, wherever they are: so they reach their health goals faster and focus on living.
Healthcare has lost its way. In recent years the “care” has fallen by the wayside — victim of flawed automation efforts, perverse payment models and the constant pressure to reduce costs. Technology is a powerful tool. However, if not used properly it’s impersonal and the human connections, which are critically important to caregiving, get lost. People are the solution to better healthcare.
People are the most underutilized resource in health. Twine Health changes the game by empowering them to take an active role in their care, learning along the way, and overtime building self-efficacy. Twine Health surfaces patients who need help at just the right time, allowing them to remain effective even as panel sizes grow. Coaches provide the ongoing support and expertise that is key to successful behavioral change. This also allows clinicians the time and focus to practice at the top of their license, interacting directly with patients when challenging medical conditions arise.
Elevator Pitch
The Twine Collaborative Care Platform is a new class of digital health technology that helps patients build self-efficacy via continuous support from coaches and their clinicians. Spun out of research performed at the MIT Media Lab, and proven cost effective via clinical trials and commercial pilots, Twine delivers results that cannot be ignored – 90 percent of patients reach their health goals (e.g., blood pressure < 140/90) within 3 months at 1/3 the cost of the standard of care.
Founder’s Story
John O Moore MD, PhD
John Moore, MD, PhD, is the co-founder and CEO of Twine Health. Moore’s passion for a better healthcare system started during his medical training where he was frustrated to learn that the best diagnostic and treatment capabilities did not result in healthier and engaged people. To be successful, Moore realized patients had to be in control of their own care, but also recognized the clear need for expert support. Moore came up with the idea for Twine Health during six years at the MIT Media Lab where he studied the healthcare delivery model and created a revolutionary approach to care: technology-supported apprenticeship. Bringing together advances in health psychology, learning science and human-computer interaction, Twine is designed to become the primary tool for teamwork between patients and clinicians. Before attending medical school, Moore received a BS in Biomedical engineering, and was a Fulbright Scholar.
Marketing/Promotion Strategy
Patients, coaches and clinicians are looking for a better way to provide and receive care – a way to make health care healthier. Twine Health provides clinicians, and the health organizations (HCOs) they work for, an effective and scalable chronic care platform that improves outcomes, reduces costs and increases patient and clinician satisfaction. The results speak for themselves:
