Medical and public health experts generally agree that socioeconomic and environmental factors have an overwhelming influence on health disparity and patient outcomes. If health systems aim to thrive under outcomes- and value-based reimbursement, they must also assume greater responsibility for the health of the communities they serve — both inside and outside of the hospital walls.
"When it comes to the social determinants of health, we know there are many more causes impacting the health of a population than access to quality medical care," David T. Feinberg, MD, president and CEO of Danville, Pa.-based Geisinger Health System said in a statement. "We want to transform healthcare at its core by focusing on preventive care, behavioral health and economic growth."
This desire led Geisinger to create a comprehensive new population health management program called Springboard Health. The program, which launches in Scranton, Pa., will focus on coordinating and collaborating with local stakeholders to alleviate chronic medical conditions, eliminate preventable cancers and address the socioeconomic health of the community.
Here, Dr. Feinberg took five questions from Becker's about the initiative.
Q: What prompted Geisinger to create Springboard Health?
Dr. Feinberg: I think we just got tired of hearing about social determinants of health. We thought, what if we just eliminated them? Wouldn't that be better for all the people we care for? There's all this discussion of food deserts, food insecurity, high rates of substance abuse, lack of transportation, poor housing… the list goes on. We decided we needed to stop naming these things as excuses and instead treat them as opportunities for us to improve the health of our community.
Q: What are some of the initiative's key components?
DF: I would say they fit into four categories. The first one is engaging the community. At the broadest level, we've enlisted world-class international advisers who have already enacted components of this project in other places. We also work with many community organizations in Scranton that are already doing a lot of this work. Most importantly we're engaging the actual community members in Scranton who are receiving many of these health and social services. They are smarter than any of the other groups I've already mentioned, because they know what works and what doesn't.
The second component is a fresh food pharmacy, which we first launched in November in Shamokin, Pa. We ask people, "Do you worry about not having enough food?" and "Have you skipped a meal because you don't have enough food for you and your family?" Anyone who answers yes to either of those questions and is diabetic qualifies for the food program. The healthy food they get from the program is enough to feed the participant and their family for a week. If they live in a motel, they get a hot plate, microwave and utensils. We provide everything. The results have been amazing. One hundred percent of patients have lost weight, decreased their use of medication, lowered their cholesterol and improved their hemoglobin A1C levels.
The third component is genomics. We've been an early adopter of looking at genomics in an entire population. We've now gotten consent from 160,000 patients to have their whole genome coded and combined with our EHR, and we've contacted about 3 percent of patients who we've found have a bad genetic mutation that is medically actionable.
The fourth component is data analytics. We use EHR data and information from each of the three previous components to determine where the hotspots lie and where we can deploy interventions to address the social determinants of health. We can use analytics to identify people who are frequent ER users, or people who could benefit from the fresh food pharmacy. While still following HIPAA, we know who to reach out to in the community and how to engage them in the most effective way.
Q: Why did Geisinger choose to launch the program in Scranton?
DF: Scranton jumped out as an ideal place to start for a few reasons. First, it's a town that a lot of people have heard of. Not too long ago it was quite prosperous — 50 years ago, when coal was a big deal. Then it hit hard times. The struggles of Scranton represent those of a lot of post-industrial cities in America. It made more sense for us to launch Springboard Health there than some of our more rural locations, although I think many of the interventions we create in Scranton will be effective regardless of where we do them.
Q: What makes Springboard Health stand out from other population health management programs?
DF: I think population health is a term we use a lot in healthcare now, but people aren't really clear on the definition. For example, it could mean we take congestive heart failure patients and give them scales at home and have nurses call them from time to time. That's directing interventions at a certain population. What makes what we're doing radical is its inclusiveness. Anyone in the community can benefit. If we make people better, but they aren't insured by us or seeking healthcare from us, it's still a win.
Q: As healthcare continues to evolve toward value-based care, what must health systems focus on in regards to addressing social determinants of health?
DF: When health systems do a community needs assessment, they might find high rates of substances abuse, mental illness or diabetes. Then they put the report on the shelf and do the same assessment the next year, and find the same things.
The only thing many organizations do to fix these issues is launch tiny little pilots. We have to be done with pilots. We have to eliminate the social determinants of health and challenge others to do it too. Instead of just writing up a report, give it some lip service. We used to be in that category too, but now we're challenging ourselves to be different.