Philadelphia program sends caseworkers to disadvantaged neighborhoods to improve outcomes

Philadelphia skyline at night
A program that asks patients in disadvantaged neighborhoods what they need to improve their health yields improved outcomes and saves money. (Image: Getty/Ultima_Gaina)

An innovative program run by the University of Pennsylvania Health System uses a patient-centric focus to extend care beyond hospital facilities and into local communities.

A new case study (PDF) describes the Individualized Management for Patient-Centered Targets (IMPaCT) care model developed by Penn’s Center for Community Health Workers, which has demonstrated improved outcomes and a two-to-one return on investment. The key to the program’s success lies in sending its community health workers into disadvantaged neighborhoods throughout Philadelphia and asking patients what kind of support they need to improve their health.

RELATED: Brigham and Women's 'home hospital' model slashes costs in pilot study

Webinar This Week

Optimizing Healthcare Operational Excellence to Drive Care Transformation

Join us in this webinar to learn how organizations have leveraged modern technology to enable transformative innovation and continuous improvement across their operations resulting in overall cost savings, process optimization, and clinical improvements.

That approach involves a bit of a leap of faith for physicians whose typical focus lies within the four walls of the hospital, Shreya Kangovi, M.D., who developed and launched the model, told the CEO Council for Growth. “The million-dollar question in this field is ‘Can you achieve hard outcomes by addressing the non-medical issues that affect patients’ daily lives?” she said.

RELATED: Lessons from a payer-led behavioral health home model

Asking patients their opinion on what they need to improve their health has allowed the program to provide flexible, customized support to address non-medical issues that might otherwise hinder outcomes, such as mental health problems, social or economic issues or relationship difficulties among family members. As simple as the question might seem, Kangovi points out that it gets patients more fully involved in their own care. “It elicits what patients want and it gets buy-in,” she said.

Other recent studies have reported cost savings and improved outcomes from expanding care into patients’ homes and offering behavioral health support to improve post-acute care. The likelihood of a patient who met with a worker from the IMPaCT model visiting a primary care practitioner for follow-up within two weeks of discharge was 52% higher than average, according to the case study.

The study’s success has generated enough interest from other healthcare programs that the program has recently prioritized making its model more broadly available via an online learning system.

Suggested Articles

The Senate passed a short-term funding bill that includes a monthlong delay of payment cuts to safety-net hospitals.

Humana is seeing significant cost savings and reductions in unnecessary care through its value-based Medicare Advantage arrangements.

At least a dozen expert commissions, federal health IT panels and medical associations have called for tracking EHR safety risks only to be thwarted.