By Ned Calonge, MD, MPH
For too long, the focus in health policy was exclusively on what happens in the doctor’s office. We now know that a host of other factors—from where people live and work, to how often they see their friends and how much they make—have an impact on health.
That’s not to say that hospitals, physicians and nurses don’t have a role in improving population health. They do. In fact, health care providers now have huge opportunities to build on the advances of the Affordable Care Act and other developments to drive improvements in community health.
Some of the best strategies in this arena were laid out by the American Hospital Association in 2011, and they haven’t changed. They include building an integrated, team-based approach to care, using evidence-based practices to improve the quality of care and safeguard patients, reforming payment structures and developing (and using) integrated electronic health records.
Luckily, for health systems hoping to make changes, good models have emerged all over the country.
- In Massachusetts, the Cambridge Health Alliance created a web-based registry to assess prescriptions and medication adherence for the treatment of childhood asthma, while home visits by providers helped parents decrease asthma triggers.
- The University of Chicago Medical Center worked with community clinics to create the South Side Healthcare Collaborative, a partnership to encourage patients to find a medical home. Patient advocates were placed in the emergency department to refer the least sick patients to more appropriate care, or help them find a primary care physician for follow-up visits.
- In Montana, the Billings Clinic enrolls patients, regardless of insurance status, in its disease registry and management program. Primary care providers are given data profiles on diabetic patients before appointments, including real-time reminders on diabetes outcome measures.
There are some steps that providers can take unilaterally: Providing translation services and patient navigation, for instance.
Other changes require collaboration with public health officials. Patients with chronic diseases like asthma, diabetes and congestive heart failure, for example, have been shown to benefit from care coordination along evidence-based guidelines.
Unfortunately, care for these diseases is too often delivered in fragmented, piecemeal fashion, instead of addressed as a public health issue. Why not take them on in the same way that infectious disease outbreaks or smoking are tackled, in collaboration between health care providers and public health authorities?
Clinicians and health care organizations also have a role to play in addressing the social determinants of health. Some physicians choose to do this directly, for instance through a program developed by Health Leads. This model allows health care providers to screen for critical challenges outside the medical arena, and then “prescribe” basic resources like food and home heating.
But that’s not the only way to act. Health care providers are in a good position to assess the health of their communities, and to create strategies to address community needs. On a policy level, they can become active in legislative activities that relate to health care and the social determinants of health, by testifying in committee hearings or contacting state legislators.
Or they can get involved at a local level. Regional county organizations, county commissioners, mayors, city managers, city councils and school boards routinely take actions that affect community health. So, for that matter, do hospital boards.
Within the doctor’s office, there are a great number of steps that providers can take to improve population health. Outside, there are even more.