Healthcare reform has forced a great number of health system executives across the country to rethink their missions, strategy and business models. For Randy Oostra, president and CEO of Toledo, Ohio-based ProMedica Health System, the outcomes of this exercise led to something he never anticipated: ProMedica advocating for ending hunger on a national stage, and funding numerous anti-hunger programs across his city, state and region.
How did the health system jump from preparing to a new business model to a national leader against hunger?
The story begins about four years ago, when the health system set out to updates its mission statement. As leaders met with employees and the board, a new focus for the organization emerged: "To improve your health and wellbeing."
"But there's no asterisk," says Mr. Oostra. "The asterisk is 'only in our four walls.'"
Many health systems are now shifting their care delivery to population-based models, which require hospital-based providers look outside their organizations and into the community to keep individuals as healthy as possible.
While hospitals have long set aside a small portion of their budgets on community benefit programs, Mr. Oostra and the ProMedica board quickly began to realize that in order to keep individuals healthy, it would need to do a lot more within its community to impact social determinants of health.
In fact, social determinants account for roughly 70 percent of overall health, with actual medical care accounting for just 10 percent, according to research on the subject.
The realization came as the system began work to reduce obesity rates in its community. During exploratory discussions with community leaders and groups and school leaders and children, "Very, very quickly the conversation led back to nutrition and hunger,"says Mr. Oostra.
After all, cheap food isn't usually healthy, and many communities in urban areas lack access to fresh fruits and vegetables or unprocessed foods.
1 in 6 Americans face hunger in the U.S. In Toledo, it's 1 in 5. 800,000 of the city’s students qualify for free meals.
Individuals with food insecurity are 2.9 times more likely to be in poor health, at greater risk of developing type II diabetes, and more likely to exp
erience depression, anxiety and other mental and behavioral issues than their better-fed counterparts.
Seeing how closely hunger was linked to obesity "startled us more than anything, but started to challenge us," says Mr. Oostra. "It was a light bulb moment for us."
Mr. Oostra and other system leaders approached the board, worried about their response. To his surprise, the board encouraged the system to forge ahead. After all, there was no better way to carry out ProMedica's new mission. There are few things more foundational to health than nutrition.
Interestingly, studies have shown that women with food insecurity are more likely to be obese, and a handful of studies have found that children facing food insecurity are more likely to be obese.
ProMedica's response to this new-found focus can serve as a model to other providers. It didn’t launch any groundbreaking, never-tried before programs. It didn’t invest millions to create a new food bank. Instead, it made relatively small investments in resources to improve and connect the existing anti-hunger framework already in the community.
What did ProMedica do?
70,000 pounds of food for less than $400 a week
ProMedica asked local restaurants to donate extra, unserved food to local food banks. To make it easy and ensure food safety, ProMedica employed two part-time workers, paid around minimum wage to pick up and deliver food to local food banks and shelters.
In 2013, the program delivered 70,000 pounds of food, or 55,000 meals, to local shelters and food pantries. The lucky residents at one shelter even got a lobster dinner, thanks to a local casino that donated its food surplus.
Food scarcity screenings
Last year, the health system's providers began to screen for food insecurity as patients presented to their office or the hospital. Employees were passionate about the cause, donating $65,000 of their own money to kickstart the screening program.
Providers were trained to ask patients simple questions to assess food scarcity, such as "within the last 12 months, have you been worried your food would run out before you could buy more?"
Patients who are identified as having hunger issues are connected to community resources, and inpatients at risk are given an emergency food supply upon discharge. ProMedica has also received approval to accept Supplemental Nutrition Assistance Program applications, which saves those eligible for the program from making a separate trip to a state department of health office to apply. It also hosts a WIC program office.
Numerous at-risk patients have been identified and helped because of the screenings, including an elderly man whose "younger, 65-year-old girlfriend" took all his money, leaving him with just $10 a week for food, which he spent on three frozen dinners that he stretched throughout the week. Embarrassed by the situation, the man didn't tell anyone about his lack of food until a screening identified him as in need of better access to food.
ProMedica is currently in talks with a retail pharmacy chain to begin hunger screenings at its locations nationwide.
As one soon-to-retire physician told CMO Lee Hammerling, MD, helping to implement the anti-hunger programs were his "proudest moment working for us in 33 years."
Expanding summer food programs
For many children, at-school meals are their only consistent food source. In the summer, they lose this safety net.
When ProMedica became aware Lucas County, where it's located, served just 1,500 summer meals to children in 2011, it partnered with the National Alliance to End Hunger to expand the program.
"We reached out to partners," asking them to identify the best sites for the program and to promote it to families, says Barbara Petee, chief advocacy and government relations officer at ProMedica. "We have convening power that a lot of other organizations don't in a community."
The following summer, the County served 45,000 meals; the number jumped to 100,000 for Summer 2013.
Advocacy efforts
Since beginning its anti-hunger efforts, ProMedica has become a recognized advocate for improving hunger issues nationally. In March 2012, it hosted a hunger summit for 100 community partners to better organize anti-hunger work in the Toledo metro area. Last November, the system was approached by the USDA to host a regional summit, which took place May 14th in Chicago. The summit, a partnership between ProMedica, the National Alliance to End Hunger and the USDA, brought together more than 100 anti-hunger advocates to share best practices.
Beyond hunger
For ProMedica, its work fighting hunger fits within its mission of advancing health and wellbeing — and new business model around population, preventive health — but it won't stop its efforts there.
The system plans to continue to work to bring groups together to impact social determinants of health within the community. "We want to help connect the dots more broadly in our community," said Mr. Oostra.
"We're going to continue to push forward," says Mr. Oostra. Up next: The system plans to get involved in local economic development efforts.
"This is an opportunity for great collaboration," he adds. "This isn't something a health system should do by itself." So while a health system doesn't have to go it alone, it should make use of its community and political capital to help advance efforts that benefit the community.
"We were always clinically focused, but now we're more socially focused," says Mr. Oostra.
ProMedica's new social focus has created a big positive impact for the Toledo community, and the system hopes encouraging other health systems to take on these issues will lead to nationwide improvements in the social issues affecting our nation's health.