The Healthy Nevada Project: The Ultimate Exercise In Strategic Planning

Renown Health Addresses the Components of Community Health Status to Guide 5-Year Plan

Anthony D. Slonim, M.D., Dr.PH., FACHE President and CEO, Renown Health

In not-for-profit healthcare, we have a responsibility to care for the community. Unfortunately, much of our services, staffing and efforts are devoted to healthcare not health. We often lack understanding of the factors impacting community health and can’t significantly improve these determinants because it takes too long to achieve outcomes through intervention; plus, providing programming still drives financial viability. However, systems at the forefront of population health are creating opportunities to change the status quo.

How did you start on this journey?

AS: Reno is ripe to advance population health goals largely because our state ranks near the bottom in health outcomes. In 2015, Renown’s strategic plan laid out a distinction between health and healthcare and began to invest, with our partners, in health outcomes for priority populations. We started with children, advanced to behavioral health and addiction, and then seniors. We named ‘Institutes’ to improve health for these groups.

In September 2016, we realized we were limited by a lack of robust data and knew we would not be able to impact health determinants without a data roadmap. Renown joined forces with Desert Research Institute (DRI), a global leader in environmental data analysis, to launch the Healthy Nevada Project. This landmark population health study which initially enrolled 10,000 volunteers for free genetic testing in less than 48 hours, now has more than 30,000 enrollees, and is on track to include 10 percent of northern Nevada’s population by the end of 2018. We combined participants’ genetic data with clinical data from electronic medical records, environmental data on issues like air and water quality, and social data from state registries into a data warehouse. Our scientists are evaluating these data to better understand the patterns that contribute to population-level health and disease while providing individualized feedback to participants so they can modify behaviors to reduce risks and improve health.

How did you justify investment in the project?

AS: The Healthy Nevada Project has two goals: improving community health one person at a time and catalyzing health literacy conversations between participants and their care providers. We hope providing free genetic tests will engage people in a discussion about their health and improve it. Some participants want lots of information about their genetics, risks for disease and how to make a change. Others are only interested in their ancestry. Our job is to meet participants where they are in their own health literacy journey, provide actionable data, address interests and questions, and empower them without imposing a singular approach.

We are using data to address the most frequent genetically based diseases in our population and assuring people have access to appropriate screening and intervention. We are also making our community healthier by providing early identification of chronic conditions that need treatment. Because the tests are offered at no cost, we are able to democratize the availability of genetic testing and enhance participant engagement regardless of socioeconomic status. With all of the data located in a single warehouse, our analysis can also find patterns in care services we need to improve such as ER and OR wait times, medical group no shows, and the effects of how teams work together.

What advice do you have for health systems looking to follow Renown’s footsteps?

AS: For systems looking to impact the health of the communities they serve, first, I would suggest putting aggregate medical record data to use. This can help you better understand your community’s health needs and the types of care you already provide. Healthcare has not yet embraced the use of predictive analytics on a broad scale the way other industries have. This needs to change so we can improve health nationwide.

Second, drive the conversation beyond the walls of your organization and into your community. Learn about the adverse social and environmental impacts on your region’s health and do something about it. Using Community Health Rankings, we recently published findings showing large disparities nationally in the success of health systems to impact community health (Maraccini et al).

Third, find good partners. This work is not easy. While many health systems do well on clinical analytics and programming, we do not have the analytic or warehousing capabilities for this type of work. We needed to rely on DRI for warehousing and more importantly, the data science expertise to help find data patterns. Finally, a partner like Helix – which operates one of the world’s largest clinicalgrade, genetic sequencing labs – lets us directly impact care by taking actionable data and using it for the patients we serve. Together, we are creating an unprecedented opportunity to improve the health of Nevadans.