I recently took care of Rosaria, a cheerful 60-year-old woman who came in for chronic joint pain. She grew up in rural Mexico, but came to the US thirty years ago to work in the strawberry fields of California. After examining her, I recommended a few blood tests and x-rays as next steps. “Lo siento pero no voy a tener seguro hasta el primavera — Sorry but I won’t have insurance again until the Spring.” Rosaria, who is a seasonal farmworker, told me she only gets access to health care during the strawberry season. Her medical care will have to wait, and in the meantime, her joints continue to deteriorate.
Migrant and seasonal agricultural workers (MSAW) are people who work “temporarily or seasonally in farm fields, orchards, canneries, plant nurseries, fish/seafood packing plants, and more.” MSAW are more than temporary laborers, though— they are individuals and families who have time and time again helped the US in its greatest time of need. During WWI, Congress passed the Immigration and Nationality Act of 1917 because of the extreme shortage of US workers. This allowed farmers to bring about 73,000 Mexican workers into the US. During WWII, the US once again called upon Mexican laborers to fill the vacancies in the US workforce under the Bracero Program in 1943. Over the 23 years the Bracero Program was in place, the US employed 4.6 million Mexican laborers. Despite the US being indebted to the Mexican laborers, who helped the economy from collapsing in the gravest of times, the US deported 400,000 Mexican immigrants and Mexican-American citizens during the Great Depression.
Three finalists for the Robert Wood Johnson
Foundation Home and Community Based Care and Social Determinants of Health
Innovation Challenges competed live at the Health 2.0 Conference on Monday,
September 16th! They demoed their technology in front of a captivated audience
of health care professionals, investors, provider organizations, and members of
the media. Catalyst is proud to announce the first, second and third place
Home and Community Based Care Innovation Challenge Winners
Catalyst is excited to announce the finalists for Robert Wood Johnson Foundation’s Home and Community Based Care and Social Determinants of Health Innovation Challenges! The three finalists from each Challenge will compete in an exciting Live Pitch on September 16th, from 2:30-4:30pm, at this year’s Health 2.0 Conference in Santa Clara. They will demo their technology in front of a captivated audience of health care professionals, investors, provider organizations, and members of the media. The first place winners will be featured on the Conference Main Stage, September 17th at 3:15pm. Winners will be awarded $40,000 for first place, $25,000 for second place, and $10,000 for third place.
If you are attending the Health 2.0 Conference, join us to
see the finalists showcase their innovative solutions.
& Community Based Care Innovation Challenge Finalists
Heal – Heal doctor house calls paired with Heal Hub remote patient monitoring and telemedicine offer a complete connected care solution for patients with chronic conditions.
Ooney – PrehabPal, a home-based web-app for older adults, delivers individualized prehabilitation to accelerate postoperative functional recovery and return to independence after surgery.
Wizeview – A company that uses artificial intelligence to automate and organize information collected during home visits, supporting the management of medically complex populations at the lowest cost per encounter.
Determinants of Health Innovation Challenge Finalists
Community Resource Network – The Social Determinants of Health Client Profile, a part of the Community Resource Network, creates a whole-person picture across physical, behavioral, and social domains to expedite help for those most at risk, fill in the gaps in care, and optimize well-being.
Open City Labs – A company that matches patients with community services and government benefits that address SDoH seamlessly. The platform will integrate with HIEs to automate referrals, eligibility screening & benefits enrollment.
Social Impact AI Lab – New York – A consortium of nonprofit social services agencies and technology providers with artificial intelligence solutions to address social disconnection in child welfare.
Today on THCB Spotlights, Matthew talks to Jacob Reider. Jacob is the CEO of Alliance for Better Health, one of New York State’s 25 Performing Provider Systems which work to reduce unnecessary or preventable acute care utilization for Medicaid members by improving the health of communities. Alliance for Better Health has a new approach to this—they’ve created an Independent Practice Association (IPA) called Healthy Alliance IPA to pull together community based organizations focused on improving health and addressing the social and behavioral aspects of health. Their approach helps the 29 organizations within the IPA negotiate funding and creates an infrastructure for integrating social determinants of health into health care. Watch the interview to find out how this is going to work in practice.
The growing movement to include the patient voice in medicine through
Motivational Interviewing, patient-reported outcomes, social determinants of health
and shared decision-making
One day in 2011, as a part of my research on ways to improve patient-provider communication about health behaviors, I was shadowing Dr. G., a talented young internist with a cheerleader demeanor. He marched through 12 afternoon patient appointments with confidence and purpose. But when he saw the name of the last patient on his schedule, he turned pale, faced me and said, “I apologize for what you are about to see.”
I must have looked confused. He repeated, “I
apologize for what you are about to see.”
We walked into the exam room. I’m not sure either
one of us knew what to expect. The patient, a white, obese man, was seated,
doubled over. He had a wad of paper towels jammed in his mouth. He threatened
to pull out his own, presumably abscessed, tooth. He refused to see a dentist
because he had no dental coverage, no money and no one to borrow money from. He
said he would use pliers to pull his tooth, but stayed put, rocking in his
seat. At the computer, the young doctor’s white-knuckled hand gripped his
mouse. Click. Click. Click. He searched the patient’s chart aimlessly for help.
Alerts kept popping up about the patient’s missing A1C results. It took two
minutes, but it felt like 20.
Dr. G. left the room and came back a few minutes
later. He gave the patient the name of a dentist who would see him at no cost.
I suspected Dr. G. had called the dentist and said he would pay for the
appointment out of his own pocket. The patient hugged Dr. G. He only wanted
help, and Dr. G. wanted to help. The tension was resolved for the moment.
Health disparities domestically and globally can often be attributed to social determinants of health (SDoH). According to Healthy People 2020, SDoH are conditions and resources in the environments in which “people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Examples of these include: resources to meet daily needs (e.g. access to and quality of housing and food markets), educational opportunities, employment opportunities, and transportation. Despite well-established literature on the importance of SDoH, these factors are often overlooked and excluded in health care frameworks.
Concurrently, health services provided in
traditional settings such as hospitals and clinics can be expensive and
inaccessible. There are a large number of communities, from rural areas to
major cities, that are in need of high-quality care. Innovative technologies
can mitigate these challenges. Home and community-based care models coupled
with digital tools provide the opportunity to serve patients where they feel
most comfortable in a cost-effective manner.
For the SDoH Challenge, innovators were asked to
develop novel digital solutions that can help providers and/or patients connect
to health services related to SDoH. Over 110 applications were submitted to the
SDoH Challenge. For the Home and Community Based Care Challenge, applicants
were asked to create technologies that support the advancement of at-home or
community-based health care. Nearly 100 applications for Home and Community
Based Care Challenge were received.
Slide into Health in 2 Point 00 (or rather, Health 2.0 HIMSS Europe) with Jess and I today! On Episode 84, Jess asks me about the big news that CVS has now made it possible for employees to get reimbursed for Big Health’s Sleepio, an insomnia digital therapeutic, and about Atrium Health’s $10 million investment in an affordable housing plan, addressing the social determinants of health. Hear some of my key takeaways from the conference so far, too. –Matthew Holt
Nearly a decade has passed since Healthy People 2020positioned social determinants of health (SDoH) at the forefront of healthcare reform. As defined by the report, SDoH are the “conditions in the environment in which people are born, live, learn, work, play, worship, and age, that affect a wide range of health, functioning, and quality of life outcomes.” Examples of social determinants include:
Resources to meet daily needs (e.g., safe housing and local food markets)
Educational, economic, and job opportunities
Community-based resources in support of community living and opportunities for recreational and leisure-time activities
The ability to influence
social determinants largely falls outside of the health care system’s reach.
Therefore, a key to address opportunities for health involves collaboration between
health care and different industries such as education, housing, and
transportation. Both the public and private sectors have made significant
efforts to bridge the gap between physical, mental, and social care by
experimenting with non-traditional partnerships.
The Center for Disease Control and Prevention (CDC) has spearheaded multiple programs with government agencies and community partners to achieve the goals outlined in Healthy People 2020. One of the most notable successes is the Childhood Lead Poisoning Prevention Program, an initiative by the CDC with the Department of Housing & Urban Development and the U.S. Environmental Protection Agency. Through housing rehabilitation, enforcement of housing and health codes, and partnerships with healthcare experts, the program helped Healthy People 2020 exceed their target of reducing blood lead level in children.
Other programs such as the “National Program to Eliminate Diabetes Related Disparities in Vulnerable Populations,” leveraged community partners and resources to increase food security, health literacy, and physical spaces for active living. In one of their projects, the program partnered with community health workers (promotoras) who spoke Spanish to engage with Hispanic/Latino communities where participation to Diabetes Self-Management Education (DSME) was low. The community health workers provided linguistically and culturally-sensitive materials that effectively increased participation in DSME among the targeted population. The outcomes from such initiatives have inspired more health and community organizations to work together to reduce health disparities.
Today on Health in 2 Point 00, Jess is in Italy…and has me up far too early in the morning for this episode. On Episode 79, Jess asks me for an update on uBiome after their raid by the FBI. We also talk about nutrition startup Noom’s $58 million raise and clinician house-call platform DispatchHealth’s $33 million raise. In other news, Kaiser Permanente is launching a network to integrate the social determinants of health with their EHR. –Matthew Holt
By SAMYUKTA MULLANGI MD, MBA, DANIEL W. BERLAND MD, and SUSAN DORR GOOLD MD, MHSA, MA
Jenny, a woman in her twenties with morbid obesity (not her real name), had already been through multiple visits with specialists, primary care physicians (PCPs), and the emergency department (ED) for unexplained abdominal pain. A plethora of tests could not explain her suffering. Monthly visits with a consistent primary care physician also had little impact on her ED visits or her pain. Some clinicians had broached the diagnosis of functional abdominal pain related to her central adiposity, and recommended weight loss. This suggestion inevitably led her to become defensive and angry.
our standard screen for safety at home had been completed long ago, I wanted to
probe further, knowing that many patients with obesity, chronic pain and other
chronic conditions have suffered an adverse childhood – or adulthood –
experience (ACE). Yet, I hesitated. Would a busy primary care setting offer enough
latitude for me to ask about a history of trauma when it can occur in so many
forms, in so many ways and at different times of life? Furthermore, suppose she
did report a history of trauma or adverse experience. What then? Would I be
able to help her?
I began: “Jenny, many patients with symptoms like yours have been abused,
either emotionally, physically, or sexually, or neglected in their past.
Sometimes they have suffered loss of a loved one, or experienced or witnessed
violence. Has anything like this ever happened to you?”
yielded our first breakthrough. Yes, she had experienced neglect, with parents
who were separated for much of her childhood, and then later divorced. She had
seen her father physically abuse her mother. With little parental oversight,
she had engaged in drug and alcohol use throughout her teenage years. But, she
wanted to be sure we understood that this was all behind her. She had gotten an
education, was in a committed relationship, and had a stable job as a teacher.
That part of her life was thankfully now closed.