Five years ago, Keith Gray, MD, wasn't overly familiar with the term "social determinants of health." He was also surprised to learn that 173,000 people were living in at-risk zip codes around Knoxville-based University of Tennessee Medical Center, where he was practicing as a surgical oncologist.
Dr. Gray recalls giving a lecture to local community members in 2015 during which he said two-thirds of cancer could be prevented if people ate fresh fruits and vegetables and exercised.
"I immediately had about three hands go up in the lecture," Dr. Gray said during a recent interview with Becker's. "They asked, 'Where are we supposed to get those fresh fruits and vegetables? And secondly, where are we supposed to exercise?'"
"I didn't believe them at first," Dr. Gray said. That is, until he started driving around these communities and found 3-mile stretches void of a suitable grocery store.
Today, Dr. Gray serves as CMO of UTMC and is helping to lead a comprehensive 10-year effort to reduce health disparities and promote health equity and wellness in the Knoxville area.
He spoke with Becker's about how the initiative took root five years ago, where they are now and what outcomes he hopes to see in five years.
Five years ago
As an initial assessment, UTMC leaders looked at Community Needs Index scores for each zip code in its county to identify pockets of healthcare disparity. They discovered about one-third of Knox County residents lived in disparate zip codes that put them at heightened risk for health issues.
"As the region's only academic medical center, we thought it was our responsibility to take the lead on addressing this," Dr. Gray said.
The first step in UTMC's planning process was to learn about local community structures and identify key stakeholders. In many of Knoxville's urban areas, community leaders often came from churches and fraternities.
"We had to get to know these folks and get a seat at the table with them," Dr. Gray said. This often entailed taking leaders out for breakfast or visiting churches to learn what issues they faced.
"As we started to listen more and take them to breakfast, we realized what their needs were," Dr. Gray said, mentioning the prevalence of food deserts, housing insecurity and violence in some of the communities. "From there, we determined what we could offer and what partnerships we could form with other community leaders."
UTMC ultimately landed on a comprehensive population health strategy Dr. Gray shared in simple terms: build community trust to establish community engagement through community partnerships.
Today
After five years of planning and preparation, UTMC rolled out two major population health initiatives as part of this 10-year strategy in December 2019.
The first is the Lonsdale Health Center, which opened Dec. 12 through a partnership with UTMC, Knoxville-based Cherokee Health Systems and the Emerald Youth Foundation, a local Christian youth ministry. The health center offers healthcare services for community members with acute and chronic conditions regardless of insurance type. UTMC aims to equip patients with wellness and prevention strategies at the center and plans to eventually offer additional community health programs on topics like fitness and nutrition.
The health center is housed within a larger community center that includes a 30,000-square-foot multipurpose room, two synthetic turf sports fields and a fitness area, among other amenities to promote exercise and wellness.
"The community has been very engaged in the overall facility," said Dr. Gray, adding that he makes it a priority to periodically visit the health center and interact with community members.
"Eventually, I hope to have conversations with people about their health goals and how we can help achieve them," he said. "There has to be some engagement in the same space before you can start to shape people's healthcare habits."
UTMC also reopened the Free Medical Clinic of America Dec. 16. The clinic was temporarily closed for renovations after its founder, UTMC-trained hematologist/oncologist Tom Kim, MD, retired in November 2019. The clinic offers free healthcare services to uninsured patients, with some laboratory and diagnostic services costing a nominal fee. It also screens patients for health barriers and connects them with relevant community agencies, as necessary.
UTMC aims to build on Dr. Kim's legacy, who treated more than 16,000 uninsured patients at the clinic since 1993. So far, it's off to a good start.
"In the first six days we were open, we saw 95 patients," Dr. Gray said. "Out of those 95, 20 patients were new. About 10 percent were referred on for additional specialty care or diagnostic needs."
Five years from now
UTMC is in the first year of its 10-year plan to eliminate healthcare disparities and achieve a healthier community in the Knoxville area.
So, what does Dr. Gray hope to see in another five years?
For one, he hopes UTMC will partner with other healthcare organizations in the area to bolster this effort and boost the community's trust in healthcare institutions.
The healthcare industry unanimously understands that tackling social determinants of health is crucial to improving population health and lowering spending, Dr. Gray said, but no one knows the best way to do it yet. In five years, he expects UTMC will have measurable results to shed some insight on this process.
"I realize this is a problem we're probably not going to solve in my lifetime and probably not yours," he said. "But I hope we have some quick wins, a formula that works and a group of folks interested in moving the initiative forward. Then it becomes a question of not how to do it, but do we have the workforce and the funding to make it all work?"
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