Health Policy Innovators Shifting Focus from Hospitals to Communities

Andrew Kitchenman | October 20, 2015 | Health Care
At NJ Spotlight On Cities, cross-sector partnerships -- including healthcare providers, businesses, schools -- cited as key to healthier urban centers

Credit: Amanda Brown
Barnabas Health Senior Vice President Jennifer Velez
There is a growing consensus among health-policy innovators about what will lead to healthier residents in New Jersey’s cities and towns — and it won’t be found primarily within hospital walls.

Instead, it will take place through the work of broad coalitions of healthcare providers working with social-service agencies, businesses, schools, local governments, and engaged residents to establish a culture that will encourage healthy living.

That was the view of three people who are at the leading edge of health innovation in the state — Barnabas Health Senior Vice President Jennifer Velez, Robert Wood Johnson Foundation program officer Jasmine Hall Ratliff, and Camden Coalition of Healthcare Providers general counsel Mark Humowiecki. They spoke at a panel at NJ Spotlight on Cities, a conference in Newark on Friday.

Much of the focus on Newark healthcare in recent days has been on the fate of Saint Michael’s Medical Center, which is set for a sale in bankruptcy court early next month. Velez, whose employer may bid for Saint Michael’s, declined to directly address the hospital’s future, saying that it “will play itself out.”

But Velez spoke passionately about the need for residents of Newark and other cities to receive the healthcare that they require in the appropriate setting — hospitals for emergencies and inpatient procedures, but settings that are “more ambulatory, outpatient, accessible for breast care, for screening, even for chemotherapy.”

Velez repeatedly referred to what the goals of both Barnabas and the broader healthcare system should be — improved health outcomes, whether they occur through traditional hospital services or through the work of people outside of healthcare.

It’s that broader perspective on improved health that attracted Velez to Barnabas.
She is the former state commissioner of human services — a position she described as “the best job on the planet.” But she had what she calls a “you had me at hello” moment in deciding to work for Barnabas when system President and CEO Barry Ostrowsky described his goals to her.

“If we’re successful as we move forward in this new space, this new mission … we will be a human services-facing organization as well,” Velez recalled.

Hall Ratliff noted that the Robert Wood Johnson Foundation for the past two years has focused on building a culture of health. In New Jersey, that’s occurring through different coalitions built around goals like improving the diet and exercise of children, such as the New Jersey Partnership for Healthy Kids, as well as a new 10-city grant program aimed at building coalitions that will advocate for lasting policy changes to improve community-level health.

For example, the foundation helped fund a wide-ranging effort in Vineland that has led the city to adopt a new policy to redesign its streets to make it safer to walk and bike. In addition, it worked with a local grocery owner to find financing to move to a more accessible location, and with local schools to improve students’ nutrition and physical activity. These structural changes have paid off, with the community receiving a grant from the U.S. Centers for Disease Control and Prevention to expand its work.

Humowiecki said information sharing, both inside and outside of healthcare, could help residents improve their health. He pointed to a Camden program in which church members agree to allow healthcare providers notify their pastors when they’re hospitalized. This allows a trusted person to provide support while the patient moves back home — a time when it’s particularly important to receive follow-up care to prevent future visits to the hospital.

Even if much important work is being done outside of hospitals, Velez still sees health systems playing a vital role.

[related]“We are geographic anchors in our community, and I think with that comes an awful lot of responsibility. One of the biggest components of that is we can really serve as a catalyst for change” on the social factors that determine health, ranging from housing stability to education, public safety, and food security, she said.

Thus, hospitals are looking to ensure that patients aren’t “on their own” when they leave the hospital, she said.

“I think there is now, you know, this burgeoning recognition that it will go beyond a single practitioner and extend to a team of others who might in fact be outside the medical profession to ensure someone’s quality healthcare,” Velez said.

She said if she had a “magic wand” to reach Barnabas’s goals, “we would eliminate poverty,” the root of many health problems. While she said that are many people “in the trenches who have long been working” on the social causes of health problems, there’s a growing recognition to address social issues through a healthcare lens.

As an example of how complex this work will be, Velez noted that during a recent month, 39 patients visited Newark Beth Israel Medical Center due to mental health issues. Of those patients, 37 didn’t show up for their follow-up appointments, despite receiving a visit and two phone calls.

“There’s a whole number of factors that are involved in that person’s life, and we have to be so intentional in finding out who and where and why, because that person is now lost to us,” if they can’t be reconnected with providers, she said.

Velez said an outcomes-focused approach, drawing data showing what’s effective in reaching patients, presents opportunities.

“I used to take a lot of comfort — and I realize it was sort of false comfort in some regard — you know, felt very proud about Medicaid expansion and the fact that many more people have access to health insurance,” Velez said.

The next step is where patients should get that healthcare.

“What it should look like is much more access to outpatient services,” she said. “Not everything needs to be accessed through either, ‘A’, an emergency room or, ‘B’, just a hospital generally. But there should be much more ready convenient access if possible to as many outpatients … buildings as possible.”

Regardless of who owns which hospitals, until the outcomes in cities like Newark have improved, “most healthcare providers will say, we’ve not done a good job here, because our healthcare outcomes for our cities, and this city in Newark, are poor,” Velez said.

Hall Ratliff described the scope of the many factors that can improve residents’ health when she said every topic at the wide-ranging NJ Spotlight conference related back to health.

From improving education to making corporate investment that leads to good jobs — both factors linked to improved health — “this entire conference is about health,” she said.

Full disclosure: The Robert Wood Johnson Foundation provides funding for NJ Spotlight’s health coverage.