If the healthcare continuum sat as points along a river, primary care encounters could be at the head of the river. Following the river's current, one would find specialty care then, potentially, the hospital. In the movement toward value-based care, the overarching goal is to keep people out of the hospital, away from downstream, and this is the vision shared by Upstream Health Innovations, the innovation center affiliated with Hennepin County Medical Center in Minneapolis.
"We're focused on the opposite direction, on how to keep people from coming downstream, on how to get people to embrace their health and how can we help so that they stay healthy and live healthy lives," says Chip Truwit, MD, chief of radiology and chief innovation officer at HCMC.
HCMC is a safety net hospital in the Twin Cities, and as is the case for many underserved populations, the social determinants of health present a significant barrier to this patient population's access to care. If somebody doesn't have the means to get to a physician appointment on time, his or her health suffers. It is these gaps in care that Upstream Health Innovations wants to fill with innovative solutions.
In April 2015, Upstream Health Innovations received a $2.5 million grant from United Health Foundation, a nonprofit, private foundation sponsoring grants to improve health and healthcare. Upstream Health Innovations used the grant to conduct ethnographic, observational research. These studies analyzed how the social determinants of health affect patient interactions with the healthcare system.
"[We wanted to] focus on access and disparities, looking at the social determinants that influence whether patients or citizens of Hennepin County and beyond can even [address] their healthcare issues because they're focused on getting a job, finding shelter, finding food, trying to recover from substance abuse and the like," Dr. Truwit says.
Upstream Health Innovations isn't necessarily trying to solve these issues; rather, the intent is to provide resources to patients and appropriate parties to address the issues so when a patient interacts with the healthcare system, the focus is on clinical needs.
"It's not so much to get those problems out of the way but to get the right resources to get focused on solutions," Dr. Truwit says. He explains that when a patient faces social determinants of health do consult with physicians, they may ask questions regarding those determinants to the physicians, which physicians may not be able to fully answer. A physician's focus is on the clinical and can help boost patients' health, but a physician likely can't provide, say, a vehicle to get to and from appointments.
And that's where Upstream Health Innovations steps in.
The innovation center is less technological or commercialization-focused than many of its contemporaries. The innovations in development at Upstream Health Innovations can be thought of as service design, says Susan Jepson, vice president of innovation at Upstream Health Innovation. Service design seeks to best align and utilize resources to improve the quality of a service for its end users. In this case, the service to be enhanced is the healthcare system.
At Upstream Health Innovations, a key initiative is to develop a resource engine that offers patients information and solutions to some of these social determinants. Then, a note placed in the EHR identifying the obstacles individuals face can help community health and social workers provide proactive care and interventions when needed. By addressing the social determinants of health prior to a physician consultation, healthcare interactions can become more efficient, thereby aligning and utilizing resources to improve a hospital's service to patients.
"It's very important as we're moving forward to make sure we are looking at ways to address [how a patient interacts with our healthcare system] so our core competency is delivering healthcare," Ms. Jepson says. "We want to do that, but have to remove some of these obstacles."
This focus on keeping individuals healthy and out of the hospital — to keep them from moving downstream — is the inspiration behind Upstream Health Innovation's name and provides a steadfast reminder to the innovation center's mission.
"The vision, frankly, is to move care upstream to the true source of health," Dr. Truwit says, "And the true source of health means people taking care of themselves."
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