Here’s how to reform health care
February 8, 2017
Randy Oostra, President & CEO, ProMedica
We must address the social conditions and behaviors that cause illness
Reposted with permission. This op-ed was originally published by the Pittsburgh Post-Gazette website on February 2, 2017. The original post can be found here.
Our nation’s health care system is a mess. The industry spends $3 trillion annually and constitutes more than 17 percent of the nation’s GDP. For patients and their families, shouldering the burden of rising health care costs often leads to financial hardship and is the No. 1 cause of personal bankruptcy. Escalating health care costs lead many to forgo care, or patch together payments while neglecting other basic needs.
Health care reform has been discussed for more than a century, dating back to Theodore Roosevelt, who sought universal coverage. In 1946, the Hill Burton Act funded the construction and modernization of hospitals across the country. The “Great Society” legislation of 1964 established Medicare and Medicaid. And, just seven years ago, the Affordable Care Act made health insurance available to more than 20 million previously uncovered Americans.
These significant decisions — all well-intended — laid the foundation for today’s health care system, which has been broken by myriad unintended consequences. Our system is fragmented, unaffordable and lacks a key element: It fails to address the social determinants of health — the conditions in which people are born, grow, live, work and age.
As an industry, we have invested heavily in high-tech clinical care, yet we’ve significantly underinvested in societal areas where health and well-being are first established.
Think about how much time an individual spends in a doctor’s office or in a hospital; hopefully, not a lot. Now, think how one’s health is affected by hunger, poverty or not having safe or adequate housing, transportation or a sound education. Research indicates that approximately 20 percent of an individual’s health care is based on heredity and access to quality care, while the remaining 80 percent is determined by physical environment, health behaviors and socioeconomic factors.
The impact of social determinants on the cost and quality of health care has never been greater. The expense of caring for diabetics in America is at an all-time high and ranks as the No. 1 cost of treating chronic conditions, according to a study published last month in the Journal of the American Medical Association. Close behind are heart disease and back and neck pain. In 2013 alone, Americans spent about $280 billion on these three chronic conditions, which are fueled in large part by social conditions and personal behaviors.
Given this, our nation, communities and health care systems should — indeed, they must — invest significantly more to affect these social determinants of health.
In recent years, a growing number of hospitals and health systems — including my own, ProMedica — have come to embrace their role as community anchor institutions by making such investments. Efforts include screening for food insecurity, reducing infant mortality, improving mental health, addressing housing and transportation needs, helping to ensure personal safety and aiding urban revitalization and economic development efforts.
ProMedica has learned much on this journey. For instance, the cost of hunger nationally is estimated to be at least $167.5 billion, $130 billion of which is for health care. Food insecurity impacts nearly 13 percent of households, including 19 percent of homes with children, 33 percent of single mothers with children and seniors at a rate in excess of 30 percent. Such statistics are alarming, and they represent a critical issue that our industry is largely ignoring, save for the price tag of medical intervention because preventive solutions have been ignored or never considered.
To ensure the best health outcomes for our patients, we needed to expand our focus beyond advancing clinical care to include helping them to meet their basic needs. We began screening patients in our hospitals and offices for food insecurity, which led to other initiatives, including food pharmacies (whereby providers write prescriptions for food), food reclamation (working with community partners, we’ve reclaimed and served more than 300,000 pounds of food that would have been thrown away!), weekend backpack programs to help school kids stay in shape, and building and operating an inner city grocery store in a former food desert that also offers job training for neighborhood residents.
As our knowledge has grown about the link between hunger and health outcomes, we recognized the need for clinicians to understand more about our patient’s personal circumstances: Do they live in a safe home, with working utilities? Can they afford to feed their families — or themselves — without neglecting other bills? Do they feel isolated? Do they have transportation to get to work, school, the grocery store or doctor appointments? Within the next year, we’ll expand our screening to include 10 health determinants and put a system in place to connect patients in need with appropriate community resources.
We believe this approach should be replicated in communities across the nation to help put the U.S. health care system on a new path and improve the health of our citizens.
The idea of asking hospitals and doctors to screen for these determinants is gaining traction nationally, but too many health professionals use a litany of excuses not to delve in: It’s not their job; they don’t have the resources or the all-too-familiar worry of not being compensated. Still others say they’re concerned that, if their patients identify an unmet need, they won’t know how to address it. That’s the point! As an industry, we need to think less about the business side and more about our mission of caring.
So, what do we propose?
1. By 2019, providers should screen all Medicare patients on key social determinants. Benchmark data should be used to inform research and identify key areas in which to offer interventions.
2. By 2021, hospitals should provide each patient a resource guide to help them meet identified needs.
3. Nonprofit hospitals should quantify these services and report them as approved expenses to meet their charitable-contribution requirements.
4. Physicians should be incentivized to focus on social determinants of health, starting with mental health and hunger.
5. Federal research should be conducted to track the impact of these measures and how they affect clinical outcomes.
Across our nation and throughout the health care industry, we have dedicated physicians, nurses and other professionals who rise to the challenges and responsibilities of caring for others in need. They can never be thanked enough for the care they provide day in and day out.
But, each day, as they answer their calling, we refuse to heed the telltale signs of a system that is collapsing beneath us, a system weighed down by a model that was conceived with good intentions but that has run its course.
We need a new model. We need a new system. We need to pivot and take a new path.
If we don’t? The meter reads $3 trillion — and it’s running.