How Communities Can Improve Health Care

How Communities Can Improve Health Care

Sep 13, 2017 9:46 am ET

Dr. David Blumenthal (@DavidBlumenthal) is the president of the Commonwealth Fund, a national health-care philanthropy based in New York.

If all health care is local, how can local communities improve their residents’ health?

The Commonwealth Fund recently studied 306 local markets to see how the care and health of their residents changed in recent years (as measured by our Scorecard on Local Health System Performance). Fourteen stood out as winners for improving on the majority of 33 indicators of population health and System Performance.

These communities didn’t have to be enclaves of the rich and famous. Among them were seven with below-average incomes and higher-than-average poverty rates. We did in-depth case studies of three of these less-affluent winners—Pueblo, Colo., Stockton, Calif. and Paducah, Ky.—to see what they had to teach the rest of us. We found three things stood out:

1. They came together. Community leaders and stakeholders formed collaborations to improve residents’ health and address local health problems. Sometimes they had to overcome old rivalries to do so. These communities’ modest size, with populations between 170,000 and 700,000, may have made it easier to create and maintain the trust needed to work effectively together.

In Pueblo, for example, the city’s two hospitals and public health department created a new community health improvement plan in 2010. Their work revealed the breadth and depth of the region’s health problems and prompted leaders to move beyond ad hoc efforts to take collective action. After hearing about the widely known concept of the Triple Aim—which asserts that health care should strive for the tripartite goals of improved individual care, improved population health and reduced per-capita costs—Community leaders founded the Pueblo Triple Aim Corporation, a nonprofit with a dedicated staff and infrastructure. Leaders from the business community, social services, philanthropy, economic development and education, as well as Latino and other community groups, have joined. Members of the Pueblo Triple Aim Corporation are working among other things to improve healthy behaviors and reduce obesity. Pueblo was the first Colorado city to ban smoking in public spaces; the group is now working with the housing authority to make low-income housing units smoke-free.

In Stockton, the Healthier Community Coalition, made up of nonprofits, health plans and health-delivery systems, uses community health workers to offer services for the chronically ill, and provides counseling to residents affected by violence and trauma. A variety of local collaboratives has also successfully reduced smoking rates among the general population and increased breast-feeding rates among new mothers.

In the Paducah region, community coalitions have focused on improving health outcomes by promoting physical activity, reducing obesity and addressing social determinants of health. The Rotary Club and the Foundation for a Healthy Kentucky have helped to build a new health park in a low-income neighborhood, including a playground, outdoor gym, walking trail and community garden. And the Purchase Area Connections for Health—a multicounty coalition of local hospitals, health departments, representatives of city government, the schools and the United Way—is considering programs to promote community health improvement,including the possibility of pursuing Blue Zones certification for Paducah. (The Blue Zones Project encourages city planners to work with schools and worksites to promote healthy choices in eating and exercise.)

Maintaining the collaborative ethic has sometimes required ingenuity and commitment. In Pueblo, for example, Community leaders managed to avoid ideological tensions by addressing teen pregnancy as a youth-development issue rather than simply a birth-control issue.

2. They set goals and measured progress. These communities often quantified their aspirations and tracked their progress. The Pueblo Triple Aim Corporation uses a dashboard to track population health, and compare performance with other counties. The dashboard tracks measures like the rate of preventable hospital stays, the proportion of residents reporting they are in poor health, and the percent of residents lacking health insurance.

3. They used government help. The Affordable Care Act’s Medicaid expansion played a key role for all three communities. California, Colorado and Kentucky all participated in the expansion, and so their low-income residents’ benefited from greatly improved coverage and access to care.

Furthermore, Medicaid did more than just pay for health care—it also encouraged redesign of local health-care-delivery systems. This was particularly true in Stockton, where one county-sponsored managed care plan has 90% of the Medicaid market. It used its position to promote broad-scale improvements in the health system, especially by increasing access to preventive care.

Medicaid expansion was not the only federal initiative that these communities benefited from. They also received federal support to expand community health centers and to reduce unplanned hospital readmissions.

Improving the health of a community is hard work, taking dedication and sometimes a willingness to put aside self-interest for the greater good. But these examples show it can be done, even in areas that are struggling economically—if they have the will, and if government lends a hand.

Read the latest Health Report.

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