Innovative Approach to Community Medicine Includes Addressing Social Ills

Andrew Kitchenman | April 28, 2014 | Health Care
Baltimore hospital’s initiatives impress and inspire visiting healthcare professionals from NJ

Dr. John Morrissey and hospital executive Randy Komenski of Bon Secours Baltimore Health System in Maryland stand next to "Doctor Bot," used to remotely treat and interact with patients.
New Jersey healthcare providers have been building closer ties between hospitals and primary-care practices, but a Baltimore-based hospital in the neighborhood once featured on the TV show “The Wire” has drawn the attention of some of the state’s providers by going even further — providing a full range of social services

The foundation attached to the Bon Secours Baltimore Health System goes far beyond financing medical services. It has developed affordable housing in the adjacent neighborhood and provides services such as career development, adult basic education and financial literacy education.

The thinking is that extending the concept of “healthcare” by trying to improve social conditions can have a positive impact on people’s health.

The innovations at Bon Secours aren’t limited to social services, It’s also trying to focus more on preventive care, and the state has also funded advanced technology at the hospital.

Bon Secours serves as a safety-net hospital in the heart of West Baltimore, a low-income area. There were numerous vacant homes around the hospital in the late 1980s and 1990s, and open-air drug markets fueled by the crack cocaine epidemic were operating within a few blocks of the hospital.

“Folks who were coming for procedures or even interviewing for a job would come down, get caught at one of these corners, drive around the block and go home” without entering the hospital, said George Kleb, Bon Secours’ executive director of housing and community development.

This led to the hospital committing to a three-step initiative: developing vacant properties for use as housing by the community; offering social services, and including local residents in all decisions affecting the community. The foundation, now named Bon Secours Community Works, has funded 648 units of affordable housing, including a 90-unit senior housing complex.

Over time, the foundation drew on federal and private grants to expand its offerings to cover a wide range of social services, targeting homelessness, unemployment and other similar problems that affect public health.

The state of Maryland recently awarded funding to a group of healthcare providers led by Bon Secours. The money will be focused on reducing cardiovascular disease in the area served by the hospital, through a focus on increasing care coordination and access to nutrition and fitness programs.

Hospital CEO Dr. Samuel Ross said the hospital’s funding application focused on how to overcome the “social determinants” of health.

“A big piece of that was the lack of access to primary care, prevention and wellness,” Ross said of the successful application for funding.

He noted that the hospital recently launched a new primary care clinic across the street from its main building. It also installed a new electronic health record system that will help nurses coordinate patient care outside of the hospital.

In addition, Bon Secours Community Works is focusing on making sure that every person who participates in one of its programs –- such as free tax preparation — is offered a full range of social services.

“Really all of the pieces have started to fall into place, to move more in the direction of population health management,” Ross said.

Bon Secours is shifting its focus from treating the sickest patients toward trying to head off health problems before they become crises.

In addition to the funding awarded by the state, hospital officials say their efforts may get a boost from changes in how the hospital is paid. In this new approach, known as global budget revenue, insurers will pay Bon Secours a fixed annual amount. This funding level will be adjusted each year based on changes in the services that the hospital provides.

While this money won’t pay for the social services, which are funded by grants to the foundation, it will allow the hospital to bolster preventive care and wellness programs, which traditionally have not been well-funded.

Maryland’s unique “all-payer” hospital funding system helps make this system possible. This system was launched in 1976 under a federal waiver of Medicare rules. Every insurer – including government programs – pays hospitals the same amount, which is set by a state board. That makes implementing the global budget revenue system is simpler than it would be in New Jersey, where each hospital system must negotiate separate payment rates with each private insurer.

A group of about 20 New Jerseyans visited the Baltimore hospital on April 25 as part of a trip organized by the Affiliated Accountable Care Organizations, an organization that seeks to improve community-based, integrated healthcare.

Dr. Steven Linn, chief medical officer of South Jersey-based Inspira Health Network, said Bon Secours’ work is an inspiration. He noted that he worked in public health – organized efforts to improve the health of the entire public — before becoming a hospital executive.

“People said, well that’s nice, Steve, (his public health experience) sounds like a good hobby, but is completely irrelevant to anything you’re going to do as a hospital” executive, Linn said. “So to see someone put that into action successfully and really change the health status of the community they serve is extremely refreshing, and invigorating for me.”

John Jacobi, a health law professor at Seton Hall University School of Law, said it was interesting to see Bon Secours’ approach to problems that also confront Newark. He serves as vice chair of the Greater Newark Healthcare Coalition, an organization that seeks to improve the quality of and access to healthcare in the city. Jacobi noted that the coalition has been transforming itself from a gathering of hospital executives to a partnership between a wide range of healthcare and social-service organizations.

“We are clearly turning a corner where we’re developing the infrastructure to be able to take on new projects that do some of the things on a very small scale that you guys are doing so well here,” Jacobi told a group of Bon Secours executives.

Another way that Bon Secours might influence New Jersey healthcare providers is through its use of “telemedicine,” the use of technology to remotely treat patients.

Bon Secours doctors have been using advanced technology to treat and interact with patients in prisons and jails. Doctors can remotely observe patients in its intensive and critical care unit through “Doctor Bot,” a robot equipped with a screen and camera. Dr. John Morrissey said he has even controlled the robot from his tablet computer in his car.

“The hospital has been very good with technology – I have every toy in the world – but we don’t have every subspecialty, so sometimes I have to reach out for certain things,” Morrissey said.

Dawn Van Brunt, client relations manager for Pennsauken-based GEM Ambulance, noted a parallel between the telemedicine done at the hospital and the increasing use of laptop computers by ambulance workers to connect with healthcare workers.

“It’s an interesting, innovative idea,” Van Brunt said of integrating telemedicine with other healthcare services.