12 March 2019 I am working on a project to help close the health gap, which is one of the Social Work Grand Challenges (Fong, Lubben, & Barth, 2018).
By health gap I mean that some people have fewer opportunities to be healthy than other people.
There will always be inequities, but some inequalities involve basic needs. The basic needs I am talking about are called social determinants of health (SDH).
They are elements of where we live, learn, work, play that can positively or negatively impact health (HealthyPeople.gov, 2018). In other words, where you hang out impacts your health. My project focuses on negative social determinants of health and ways to resolve those issues.
"SDH" is a compact term to describe a very complex set of issues. Social determinants include things like air quality, housing, utilities, food, physical and emotional safety and other basic needs.
In the US we spend much more on health care than we do on SDH (Weiner, 2014). I would like to see this reverse because when basic needs are not met, they can lead to illness and expensive health care utilization.
There are pilot projects and research that suggest that spending on SDH will help decrease spending on expensive health care (Center for Health Care Strategies, Inc., 2018a, 2018b; Sandberg, Erikson, Owen, Vickery, Shimotsu, Linzer, M., …& DeCubellis, 2014; Morse, 2018).
The values motivating this project are compassion and fiscal intelligence. Stephen Trzeciak is a physician researcher in NJ who coined the term "compassionomics” (2018). He notes the impact of compassion on patients, cost, and providers and has found that compassion has a positive impact on all three. So you can see how compassion and fiscal intelligence go hand-in-hand.
The population I am working with includes older people living in Philadelphia who are Medicaid recipients. They are receiving home health aide services to help with personal care which is needed because of long term health problems and limited financial resources.
The problem I am trying to solve is that many of the Medicaid recipients are living with negative SDH (NSDH) but there is no formal way to know who is suffering and what the problems are. Inother words, who needs what. This information could help inform solutions. The Home Health Aides (HHAs) who routinely visit are not trained to observe for NSDH or to resolve them.
Connected with some health systems are Community Health Workers (CHWs). These are local residents who are trained to provide support tailored to the needs of individuals at high risk of hospitalization. They meet with the patients regularly to help resolve issues, encourage health-promoting behaviors, and to help set and realize realistic health goals (Kangovi, & Asch, 2018; Kangovi, Grande, & Trinh-Shevrin, 2015). Needs go unmet for those without the assistance of CHWs, even though they have home health aides in their homes on a regular basis.
My plan is to develop a home health aide training program entitled, "Think like a Community Health Worker." The home health aides currently working with these clients are very much like CHWs. They live in and understand the community. Because home health aides are on the bottom rung of the income ladder, they may also be Medicaid recipients as working poor parents. Those who receive training will work in a new hybrid position called the Home Care Community Worker or HCCW. They already possess personal care skills and the added training will provide them with the tools to recognize and resolve negative elements within the environments of their clients. For example, if the aide notices that a client with emphysema goes into the hospital every summer, consideration will be given to why that happens. Realizing that the client has breathing problems because it is hot in the house would prompt the HCCW to go through the process of getting an air conditioner for the client. If a $500 air conditioner prevents one $2,500 emergency room visit, then it is an excellent return on investment.
As noted previously, there are organizations realizing excellent returns on investment and improved patient outcomes from social determinant remediation. This information will be shared with potential collaborators. Developing these collaborative relationships will be part the program implementation and will include the Medicaid health plans and other community agencies who will provide up front services and funds to pay for resolution pathways.
At this time, CHWs make significantly more money than home health aides (Glassdoor 2018a, 2018b). When the health plans begin seeing a cost savings through decreased resource utilization, they will be asked for a higher reimbursement rate for the HCCWs. This will help improve the income of these low wage yet essential workers.
Philadelphia Salaries
CHW $38,000-$65,000 (Glassdoor, 2018a)
HHA $23,000-$34,000 (Glassdoor, 2018b)
The first step in all of this is identifying the burden of the problem and this will be accomplished by the HCCWs, newly trained to "Think like CHW." They will observe and report what they see. Resolution pathways will be developed based on their findings. This projects helps the clients by resolving negative social issues and the caregivers by increasing their responsibilities and their salaries.
References
Center for Health Care Strategies, Inc. (2018a). Transforming complex care profile: Redwood
Community Health Coalition. Retrieved from http://www.chcs.org/media/TCC- Profile-RCHC_022217.pdf
Center for Health Care Strategies, Inc. (2018b). Transforming complex care profile:
AccessHealth Spartanburg. Retrieved from http://www.chcs.org/media/TCC-Profile- AccessHealth_022217.pdf
Fong, R., Lubben, J.E., & Barth, R.P. (2018). Grand challenges for social work and society. New York, NY: Oxford University Press.
Glassdoor. (2018a). Retrieved from https://www.glassdoor.com/Salaries/community-health-worker-salary-SRCH_KO0,23.htm
Glassdoor. (2018b). Retrieved from https://www.glassdoor.com/Salaries/philadelphia-home-health-aide-salary-CH_IL.0,12_IM676_KO13,29.htm
HealthyPeople.gov. (2018). 2020 Topics & objectives, social determinants of health. HealthyPeople.gov, Retrieved from
https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
Kangovi, S., & Asch, D.A. (2018, Aug. 29). The Community health worker boom. New England Journal of Medicine Catalyst. Retrieved from
https://catalyst.nejm.org/community-health-workers-boom/
Kangovi, S., Grande, D., & Trinh-Shevrin, C. (2015, June 11). From rhetoric to reality –Communty health workers in post-reform U.S. health care.
The New England Journal of Medicine Perspective. DOI: 10.1056/NEJMp1502569
Morse, S. (2018, July 5). What Montefiore's 300% ROI from social determinants investments means for the future of other hospitals. Healthcare
Finance . Retrieved from https://www.healthcarefinancenews.com/news/what-montefiores-300-roi-social- determinants-
investments-means-future-other-hospitals#
Robert Wood Johnson. (2018). Social determinants of health. Retrieved from https://www.rwjf.org/en/our-focus- areas/topics/social-
Sandberg, S. F., Erikson, C., Owen, R., Vickery, K. D., Shimotsu, S.T., Linzer, M., …DeCubellis, J. (2014). Hennepin health: A safety-net accountable
care organization for the expanded Medicaid population. Health Affairs , https://doi.org/10.1377/ hlthaff. 2014.0648
Trzeciak, S., (2018). Can 40 seconds of compassion make a difference in health care?
Knowledge @ Wharton , Aug.6. Retrieved from http://knowledge.wharton.upenn.edu/ article/ the-compassion-crisis-one-doctors-crusade-
for- caring/?utm_source=kw_ newsletter&utm_medium=email&utm_campaign=2018-08-09
Weiner, J. (2014). Hoping For Frailty, The Policy Crisis in U.S. Elder Care, Retrieved 6/8/18 from: http://ldihealtheconomist.com/he000084.shtml.
Many people are experiencing poor outcomes because of negative social determinants of health [SDH]. These SDH are a heavy burden for those experiencing them and a heavy financial burden for those paying for the poor outcomes. The values of Compassion and Fiscal Intelligence when blended can ease the effort of resolving negative SD. Many people think they are too expensive to fix and they must be convinced otherwise. I aim to do that.
There are many ways to influence what people are talking about which in turn may impact what people do. There are technology platforms like TV, radio, Facebook, blogs, email, and YouTube, yet nothing beats a face-to-face sit down talk as a platform for telling a story. This situation allows you to express your passion and to confirm understanding as you sit eye-to-eye even though all participants’ thoughts may not be eye-to-eye. Technology is great when there is no other option although it should never replace in-person contact when it is possible. I plan to sit down with change agents like government officials and corporate heads to use my influence to direct theirs.
A blog like this might be a helpful way to formulate my thoughts as I prepare. I might get ideas from others to strengthen my presentation so I can create a colorful and descriptive picture. SD are like colors of paint; some are wonderful, some not so good. It is most important to remember, though, that colors can always be changed.