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Leadership Message: From our Executive Director, Jack Salo - August 2017

posted Aug 17, 2017, 10:45 AM by Josie Maroney

Is a Marriage Between Health Care and Community Services the Answer to Improving Health?

The evolution of health care in our country includes increasing recognition of the significant role that race, income, place, education, and associated lifestyles play in the health status of people and families. When considering what determines health status, research has shown that access to medical care accounts for only ten percent of the equation, while behavior (fifty percent) and environmental conditions (twenty percent) are the largest contributing factors.

It seems that, at all levels, there is increasing interest in how traditional, clinical health care providers can connect patients to the non-clinical services and supports essential to their health. I have been involved in many of these discussions through our work with Care Compass Network and the Medicaid reform process, as well as through our Population Health work in partnership with HealthLink NY and other rural health networks. 

As I have listened to my colleagues from the health care sector discuss the expectation that health care work more closely with the array of governmental and non-profit community health and human services providers to create a new system of care, I am left with several nagging questions. First and foremost is who pays? Where will the resources come from to connect patients to non-clinical systems and resources essential to their health? How will non-clinical health, human service, housing, transportation, food security, and other sectors meet an increasing demand for services generated by new referrals from the health care community? What value is there in collecting information on the non- medical health related needs of patients if there is a non-existent or limited service environment to support those needs?

The best illustration I can think of, where good intentions to initiate this new way of work had a reality check, was a meeting I attended early on in the formation of the East Regional Performing Unit (RPU) of Care Compass Network. Care Compass Network is our regional Medicaid reform organization and it has organized work into North, South, East, and West regions or RPUs. The East RPU is comprised of Chenango and Delaware Counties. The Care Compass Network facilitator leading the meeting was describing how the collection of community based organizations in the two-county service area could support individuals recently discharged from the hospital with an array of non-clinical but essential services to support their recovery and was genuinely excited and optimistic about this vision. What followed was an impassioned tutorial by several service providers, including the Director of Catholic Charities of Chenango County, on both the limitations of the existing safety net services (e.g., funding and associated staff cuts to support food pantries), the paucity of service providers in this rural region, and the logistical challenges and cost of serving a small, spread out rural population. Essentially, those in attendance made the point that their organizations could not meet the current need and certainly did not have the capacity to provide additional services to address new needs and referrals.

I do think having the health care and the community health and human services sectors working together in new and more strategic ways has the potential to improve the health of individuals and communities. However, we should not be naïve about the cost, time, and commitment that is needed to make this work. 

I would like to acknowledge and celebrate the opportunities that are readily available for health care and non-clinical service providers to work together, on behalf of patients, to improve health.  Sometimes a conversation can prompt a simple, inexpensive change that has a significant positive impact. Here is an example of how that can work: Bill Wagner, our Mobility Management Director, recently presented me with 2016 reports for our Mobility Management work in each of the five counties we serve. What caught my attention was the dramatic increase in the number of Chenango County cases (assistance with a specific transportation need). In 2015, Mobility Management of SCNY assisted with 70 cases.  In 2016 Mobility Management SCNY assisted with 174 cases. There were no other counties that saw such a dramatic increase in service. I asked Bill what changed in Chenango County? and he responded that after he met with Chris Kisacky, Vice President of Operations at UHS - Chenango Memorial Hospital, she had instructed staff responsible for discharging patients to attach information with the GetThere Call Center (transportation assistance) number to the discharge packet. Bill attributed this simple, inexpensive action to the dramatic increase in the number of individuals with transportation needs being assisted through the call center and the Connection to Care Program (assistance with transportation to health care appointments).

While we need to do a better job of harvesting the “low hanging fruit,” per the example above, addressing the significant non-clinical health related needs of low-income and other disparate populations will require both new resources and reallocation of existing resources. In our region, Care Compass Network has been the driver supporting this new way of work across sectors to improve individual and community health. While the work is just beginning and we have much to learn, this is a promising development that has the potential to improve the health of individuals and communities.

P.S. For those looking for the term “social determinants of health,” I intentionally left it out. I find this academic generalization to be confusing and less helpful than noting the specific non-medical factors that contribute to health or lack thereof.


-Jack Salo, Executive Director