Economists estimate that two-thirds of all the cost of health care relates to what are called social determinants of health—those factors outside the acute care setting that affect health and cost. These factors include everything from exercise and healthy diet, healthy weight, to avoiding substance abuse or other self-destructive behaviors, to ensuring that people have adequate nutrition and adequate housing. They help determine the health of the community and, as such, have been cited as key components of population health management. (Financial Risks and Strategic Implications of APMs,” iProtean, publication pending)
The Healthcare Financial Management Association profiled a few systems that are focusing on food insecurity as a component of their population health management strategy. Food insecurity, as defined by the U.S. Department of Agriculture, is a “household-level economic and social condition of limited or uncertain access to adequate food.” (“Providers Focus on Food Insecurity,” HFMA Leadership +, May 16, 2017)
Until recently, health system leaders shook their heads at the sad statistics but did not consider them directly relevant to their work. That is changing as leaders embrace the need for population health management, which means finding effective, efficient, and sustainable ways to improve the health of their patient population.
Some Statistics about Food Insecurity and the Relationship to Population Health Management
- 42 million Americans lived in food-insecure households in 2015
- 13 percent of all U.S. households experienced food insecurity at some point during the year
- Among households with children, 17 percent—one out of six—experienced food insecurity in 2015
- 30 percent of households with children headed by single women and 22 percent of those headed by single men were food-insecure
- Healthcare costs were 49 percent higher for households with low food security—in the form of reduced quality, variety, or desirability of diet but little or no indication of reduced food intake—compared with those that had sufficient food quality. (2015 Canadian study)
- Healthcare costs were 121 percent higher for those with very low food security, defined as multiple indications of disrupted eating patterns and reduced food intake. (2015 Canadian study)
Health System Initiative
About six years ago, a regional system started working on an anti-obesity initiative in response to its community health needs assessment. As its trainers went into the community to discuss obesity, they kept hearing reports of hunger. As a result, its executives began to see a direct line between food insecurity and spiraling healthcare costs. It began get a handle on food insecurity among its own patients.
In 2015, the system and the AARP Foundation co-founded a nonprofit membership coalition that addresses the root causes of health disparities by focusing on hunger and other social determinants of health. The coalition estimates that hunger contributes more than $130 billion a year to U.S. healthcare costs.
The coalition’s members—health systems, insurers, food banks and others—are working together on research, advocacy and education, including monthly webinars.
The system has screened over 57,000 people for food insecurity. A patient who screens positive for food insecurity receives a visit from a care team member to discuss community resources that may help, as well as a food “care package” at discharge.
Patients screened for food insecurity when they visit primary care physicians receive prescriptions that entitle food-insecure patients to visit a “food pharmacy” to receive several days’ worth of food for their entire household. The prescription is linked to a patient’s medical record, so staff members at the food pharmacy can help patients choose healthy foods that support their specific nutritional needs.
Other food-availability initiatives the system funds include:
- A food reclamation program
- A full-service grocery market in a food desert, (i.e., a neighborhood that lacks access to healthy, affordable food)
- A mobile farmers market
- Summer meals for kids
The system’s president & CEO noted “a moral imperative in responding to patients’ food insecurity. He said, “We spend $3.2 trillion on health care and prescribe drugs that our patients will never be able to afford—and we don’t ask people about their basic needs. To us, it seems like a lack of common sense.” (“Providers Focus on Food Insecurity,” HFMA Leadership +, May 16, 2017)
iProtean subscribers, the advanced Mission & Strategy course, When the Dust Settles, featuring Marian Jennings and Dan Grauman, is in your library. Marian and Dan discuss the complexities of moving to a value-based healthcare organization, key features necessary to ensure the board and leadership stay ahead of the curve, the importance of thoughtful and thorough assessment of options available to the organization, the risks inherent in new investments and changes in board recruitment and development.
Coming soon: the advanced Finance Course, Financial Risks & Strategic Implications of APMs, featuring Marian Jennings and Seth Edwards. In this course, Ms. Jennings discusses the importance of social determinants of health in a population health management strategy.
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