Me­mo­rial Her­mann tar­gets food in­se­cu­rity, asks if pa­tients are hun­gry

Modern Healthcare - - BEST PRACTICES - By Maria Castel­lucci

Food in­se­cu­rity is a prob­lem in Har­ris County, Texas. About 18% of adults and 26% of chil­dren in the county have dif­fi­culty ac­cess­ing food.

Re­search on food in­se­cu­rity in­di­cates that lack of nu­tri­tious foods can lead to other health prob­lems, worsen ex­ist­ing dis­eases and in­crease costs. A 2015 study pub­lished in Health Af­fairs found that food-in­se­cure chil­dren were twice as likely to re­port fair or poor health and 1.4 times more likely to have asthma com­pared to chil­dren who weren’t food in­se­cure. Older adults who were food in­se­cure also had more dif­fi­culty with daily liv­ing than those who weren’t food in­se­cure. A dif­fer­ent study found mal­nu­tri­tion in­creases health­care spend­ing by about $15.5 bil­lion per year.

De­ter­mined to tackle the is­sue, Me­mo­rial Her­mann, a 16-hos­pi­tal health sys­tem based in Har­ris County’s Houston, be­gan to ask its pa­tients in Oc­to­ber 2015 about their ac­cess to food with the goal of get­ting them health­ier by eat­ing bet­ter.

The pro­gram started in the emer­gency depart­ment in se­lect Me­mo­rial Her­mann hos­pi­tals staffed with pa­tient nav­i­ga­tors. The nav­i­ga­tors pri­mar­ily see pa­tients in the ED who are unin­sured or on Med­i­caid to help them find a per­ma­nent med­i­cal home and help pre­vent read­mis­sions, ac­cord­ing to Carol Paret, Me­mo­rial Her­mann’s se­nior vice pres­i­dent and chief com­mu­nity health of­fi­cer.

As part of the pro­gram, nav­i­ga­tors ask each pa­tient if at any time within the past 12 months they were wor­ried food might run out and if they had dif­fi­culty gain­ing ac­cess to nu­tri­tious food.

If pa­tients say they are lack­ing ac­cess to nu­tri­tious food, the nav­i­ga­tor ex- plains the op­tions avail­able in the com­mu­nity to get food.

Me­mo­rial Her­mann has part­ner­ships with sev­eral food banks in the Houston area so the nav­i­ga­tors are able to give pa­tients de­tails about the pro­grams. The nav­i­ga­tors are even trained by staff at the food banks on the ap­pro­pri­ate ques­tions to ask pa­tients in or­der to de­ter­mine if they suf­fer from food in­se­cu­rity.

The pro­gram has since ex­panded to Me­mo­rial Her­mann’s com­mu­nity health cen­ters and to all of its in­pa­tient set­tings. It is also no longer limited to just unin­sured or Med­i­caid pa­tients, but any in­pa­tient. The ef­fort has been such a suc­cess among doc­tors and pa­tients, Me­mo­rial Her­mann plans to roll it out to all ED pa­tients by Au­gust.

Physi­cians have found the pro­gram to be “eye-open­ing,” Paret said. Doc- tors were shocked to find out some pa­tients were food in­se­cure.

“You can’t al­ways look at some­one and be able to tell their sit­u­a­tion,” she said. “It points out that med­i­cal care can’t be done in iso­la­tion.”

It has also caused doc­tors to view their most dif­fi­cult pa­tients dif­fer­ently, Paret said. Pa­tients who don’t take their pre­scrip­tions or fol­low care plans are of­ten viewed as non­com­pli­ant by doc­tors. But the pro­gram opens doc­tors up to the is­sues in their pa­tients’ lives that might be prevent­ing them from fol­low­ing a care plan, such as loss of em­ploy­ment.

The pro­gram has led to changes in pa­tients’ care plans. For ex­am­ple, some pa­tients will ad­mit they can’t af­ford food be­cause the drugs they’ve been pre­scribed are so ex­pen­sive. This has led doc­tors to seek al­ter­na­tive treat­ments or cheaper gener­ics for pa­tients.

Me­mo­rial Her­mann also has be­gun to part­ner with Houston-area food banks on other ini­tia­tives.

For ex­am­ple, nav­i­ga­tors from the sys­tem visit the food banks and of­fer free con­sul­ta­tions with pa­tients to set them up with pri­mary-care doc­tors or other af­ford­able health re­sources in the area. “We re­ally want to deal with the so­cial de­ter­mi­nants of health that are driv­ing so much of the health­care spend,” Paret said.

The work done by Me­mo­rial Her­mann has in­spired other area providers to also try to tackle the is­sue. Me­mo­rial Her­mann has been work­ing with other hos­pi­tals to adopt the pro­gram. The hope is the hos­pi­tals will be able to share data so they can bet­ter un­der­stand the so­cial is­sues that af­fect the well-be­ing of Houston-area res­i­dents.

“We can be­gin to paint a pic­ture of Houston and what we can do to close care gaps,” Paret said.

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