Go­ing be­yond medicine to im­prove U.S. health

Modern Healthcare - - COMMENT - By Su­san DeVore

Last year, the Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion re­ported that while the U.S. spends more on health­care than other na­tions, we con­sis­tently ex­pe­ri­ence poorer out­comes.

But it’s not just a ques­tion of what we spend, it’s how we spend it. Out­comes are not de­ter­mined solely by health­care con­sump­tion. Poverty, for in­stance, is linked to higher rates of cancer, car­dio­vas­cu­lar dis­ease, di­a­betes, asthma and other chronic con­di­tions. And when spend­ing to ad­dress so­cial is­sues such as poverty and ed­u­ca­tion are com­bined with health­care spend­ing, a dif­fer­ent pic­ture emerges, with U.S. spend­ing rank­ing among the bot­tom third of all in­dus­tri­al­ized na­tions.

Chang­ing the health pic­ture in the U.S. means mov­ing be­yond medicine to fix­ing our sys­tems through en­vi­ron­men­tal, eco­nomic and emo­tional care. We don’t in­cen­tivize this work, pre­fer­ring to treat the ill­ness rather than to pre­vent the cause. But there is mo­men­tum to change.

Take Catholic Health Part­ners in Cincin­nati. The sys­tem has a low­in­come pa­tient pop­u­la­tion af­fected by mul­ti­ple chronic con­di­tions, all ex­ac­er­bated by so­cial is­sues. In one case, when a pa­tient lost her car and couldn’t get gro­ceries, go to her doc­tor’s ap­point­ments or get to the phar­macy, the best pre­scrip­tion was trans­porta­tion vouch­ers.

At Chicago’s Mount Si­nai Hospi­tal, com­mu­nity res­i­dents have di­a­betes rates that are three times the na­tional aver­age. Their prob­lem also re­quired a non­clin­i­cal so­lu­tion—a part­ner­ship with a lo­cal gro­cery store to of­fer healthy food and cook­ing classes.

The Pre­mier al­liance has a col­lab­o­ra­tive work­ing to make these kinds of de­liv­ery-sys­tem tran­si­tions. We’ve learned that suc­cess re­quires health coaches who visit pa­tients at home and ask if they know how to cook hearthealthy food. It re­quires in­te­grated data, alert­ing clin­i­cians when a pre­scrip­tion hasn’t been filled or an ap­point­ment was missed. It re­quires doc­tors and nurses out in the com­mu­nity, pro­vid­ing care in churches, com­mu­nity cen­ters and even on the street. It re­quires mak­ing care more ac­ces­si­ble, cul­tur­ally ac­cept­able and less costly.

The health­care de­bate has cen­tered on the pol­icy en­vi­ron­ment and the ex­pan­sion of cov­er­age. But change will take root only if it’s ad­dressed from the in­side—by doc­tors, nurses and com­mu­nity or­ga­ni­za­tions that choose to know the per­son be­yond the di­ag­no­sis.

Su­san DeVore is pres­i­dent and CEO of Pre­mier.

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