About 12 years ago, I was invited to participate as a reviewer for a grant-funded project called the Frequent Users of Health Care Services Initiative.
The grant, funded by the California Health Care Foundation and the California Endowment, was created to identify new innovative solutions to reduce the frequency of high-volume emergency department users. Our target group included those individuals who accessed EDs multiple times each month.
This was one of the earliest efforts that I am aware of to find solutions to decrease healthcare costs by putting a focus on social determinants of health. I can say that now because virtually every successful grantee in the project found that hospital costs decreased when environmental conditions and access to care (e.g. homelessness, primary care, behavioral health) were resolved.
Many of the grantee hospitals hired social workers to invest time in redirecting the frequent users to appropriate social interventions. They found, for example, that when housing needs are addressed, then ED utilization goes dramatically down.
At last week’s AHA Leadership Forum, keynote speaker Dr. Rishi Manchanda discussed this same imperative in his presentation entitled, “The Upstream Effect: What Makes Us Get Sick?” He referred to the social workers that our grantee hospitals hired 12 years ago as “upstreamists.”
“Upstreamists,” whether social worker, physician or other provider, locate the root cause problem that causes patients to return to the doctor time and time again. These root causes, which we now refer to as social determinants of health, include food, housing, education, transportation, violence, social support, health behaviors and employment. They play a key role in community health and population health.
Manchanda said that we only have a fraction of the “upstreamists” working today that we need in this country. According to the American Hospital Association and the Health Research & Educational Trust (HRET), in their recently completed report on hospitals’ role in addressing food insecurity, “research has shown that only 20% of health can be attributed to medical care, while social and economic factors account for 40% of all contributing factors for health of our population.”
In other words, we can have a greater impact on the health of our country by identifying and fixing “upstream” social determinants than by increasing the amount of medical care available.
Hospitals, of course, have a critical role to play in raising awareness of each of these social determinants and can make a difference in overall community health. HRET’s report on food insecurity recommends that hospitals do the following:
- Screen patients for food insecurity.
- Educate their patients about available federal nutrition programs.
- Connect patients and families with dietitians and nutritionists for counseling services.
- Provide free food or healthy snacks at clinics.
- Promote existing community resources, such as food trucks, food shelters, etc.
- Identify food-insecure populations in the community through their community health needs assessments.
I urge fellow healthcare executives to review these recommendations and more helpful guidance that’s available from HRET. Working together, we can make an impact on food insecurity and other social determinants of health.
Raymond Hino is an administrator at Skyway Surgery Center in Chico, California. He was previously the president and CEO of the Sonoma West Medical Center.