As organizations and agencies transition to value-based care models, many are reaching across sectors and forming partnerships to advance public health. For one example. the University of Maryland’s Center for Health Equity (M-CHE) is partnering with Cigna and area barbershops to promote colorectal cancer screening.
'Squeezing the balloon' highlights care coordination
“The traditional ‘silos’ of medical, behavioral health and social services can’t meet the needs of our population alone,” says Jim Hickman, CEO of California-based Better Health East Bay, part of Sutter Health. “Partnerships, enabled by technology and amplified by data-sharing, are the first step in changing the way we deliver care.”
He cites the group’s work with Dr. Jeffrey Brenner and the Camden Coalition of Healthcare Providers to address challenges in delivering care to patients with complex social and health needs. Better Health East Bay partner Alta Bates Summit Medical Center is one of just six U.S. hospitals to pilot the coalition’s “super-utilizer” program, which identifies hot spots in a community where health needs are high and access and services are poor.
Treating these populations is like “squeezing the balloon,” Hickman says — squeeze in one place and a new problem pops up in another. “The solution is a collaborative care model-style opportunity for learning and innovation across an ecosystem,” he tells Healthcare Dive.
Better Health East Bay’s work in the San Francisco Bay area led to the conclusion that the problem isn’t scarcity of access versus abundance, or upstream versus downstream interventions, Hickman says. Rather, it’s fragmentation of care versus care coordination. “The dynamics of the healthcare system are forcing us to change the conversation from where we deliver care to more about how and when,” he says.
One example of how this is working is PreManage ED, a public-private partnership aimed at improving care coordination for frequent utilizers of emergency department care in the Bay area. Using a data-sharing platform developed by Collective Medical Technologies (CMT), the pilot program measures changes in patient hospital utilization, regional use patterns, patient outcomes and indicators of care coordination for frequent ED users across area health systems.
Better Health East Bay’s partners, in addition to CMT, include the California HealthCare Foundation, Alameda Health System, Alta Bates Summit Medical Center and Sutter Health Research, Development & Dissemination.
“Using this system, we learned that 78% of the patients with 10 or more visits to an emergency department last year went to both Alameda Health System and Sutter Health,” Hickman says. “That’s nearly 1,000 high-utilizing patients who are shared between the two systems.”
In a survey of social workers and ED physicians, 90% said PreManage ED enhanced their effectiveness and all felt the program improved care management, according to Hickman.
Broadband for broad public health goals
On the other side of the country at the Federal Communications Commission, the Connect2HealthFCC Task Force is engaging with a wide variety of stakeholders to advance the role of broadband in public health. Earlier this year, the task force launched its Mapping Broadband Health in America, an online tool that helps providers and others pinpoint areas with high health needs and whether the infrastructure exists to enable broadband-enabled interventions.
“We want to ensure that broadband infrastructure is in the right place, at the right time to enable future connected health, especially in rural and underserved areas," says P. Michele Ellison, chair of the Connect2HealthFCC Task Force. “Our broadband health mapping platform is an excellent starting point, but no one agency or organization can do it alone. Partnerships are the key to our connected health future.”
One example is the Priority 100 List, counties in the U.S. that have both a high health need for one of more chronic conditions and that are in the lowest tier of current broadband availability. The FCC hopes the list will spark new partnerships and new interventions to address those needs.
Not every broadband partnership involves the FCC. For example, the University of Mississippi Medical Center struck a three-way partnership with C Spire, a small telecommunications company, and Intel-GE Care Innovations to bring telehealth services to people living in rural communities. In a pilot study, the collaboration reduced unnecessary ED visits to zero, at a cost savings of about $300,000. Extrapolated statewide, that would be millions of dollars saved.
But challenges remain to leveraging broadband-enabled technologies to improve peoples’ health. Most consumers aren’t aware that broadband technologies can benefit their health, so there is less demand for innovative solutions. The other big issue is lack of a far-reaching vision for the role of broadband in health.
That’s the challenge for the FCC task force. “Big data plays a role in connected health technologies,” says M. Chris Gibbons, chief health innovations advisor to the Connect2HealthFCC Task Force and CEO of Greystone Health IT Solutions. “We need to use all available data, from EHRs to sensors in homes and hospitals to smart vehicles, to not only look at how we can help individuals, but whole populations.”