A collaborative way for low-income patients to maintain health and self-esteem

Having once worked for a Medicaid HMO, I witnessed first-hand the impact that charity "free care" (in which individuals receive without having the opportunity to give back) had on an individual's self-esteem, not to mention their health. This Medicaid program did well at supporting individuals through health crises, but lacked any real focus on improving the overall health status of an individual and a community. The key missing ingredient: Supporting the patient's self-esteem.

My organization, True North Health Center in Falmouth, Maine, collaborates with a service exchange known as the Hour Exchange to offer an innovative, alternative monetary system where members trade services with one another. The Hour Exchange helps folks with limited financial means to "pay" for their care by providing services and performing tasks needed in the community.

In exchange, these folks receive access to integrative health care services at True North, including cutting-edge chronic disease management, preventative family medicine and complementary and alternative therapies. By giving people a way to "pay" for their care, the focus is on giving, receiving and maintaining one's self-esteem and dignity.

Likewise, Franklin Memorial Hospital's Contract for Care allows people to volunteer and work off their bills when they can't otherwise pay for them. This empowers individuals to give something in exchange for what they receive, thus maintaining their self-esteem and dignity.

In each of these cases, there's no need for government interventions. Providers receive reimbursement for their time and effort (in the form of "time credits," which they can "spend" on other services provided by Hour Exchange members) and patients' self-esteem is not harmed. In fact many patients are better positioned to get well because they have maintained their self-esteem.

In the case of True North, there are pilot studies that show people who access healthcare through this collaboration not only have access to care, but also significantly improve their overall health status.

These are only two creative options that position individuals and communities for cost-effective and efficient healing by impacting one root cause to social challenges (low self-esteem). There are various other opportunities to focus on the root causes and barriers to healing, and we all need to continue to be open, creative, innovative and engaged, in order to reach the goal of providing access and positioning people for true healing.

Thomas Dahlborg is the executive director of True North, a Falmouth, Maine-based medical practice, where he is dedicated to improving the organization's growth while also improving access for the uninsured and the elderly. Prior to joining True North, he was the chief business strategy officer at Network Health, a comprehensive Medicaid health plan based in Cambridge, Mass., and the COO of U.S. Family Health Plan at Martin's Point Health Care in Portland, Maine.

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