Patients connected with essential social services
At Lankenau Medical Associates, a primary care practice, patients take a social needs survey while waiting to see their provider. Survey topics include whether patients are able to afford medication, have health insurance, or are running out of food before the end of the month. The survey also asks about patients' transportation, employment, housing, nutrition, and day-to-day living. Based on the patients' answers, the care team may notify the volunteer Medical Student Advocate (MSA).
The MSA, a second-year medical student at PCOM, reviews the results and identifies available community resources to help patients. The MSA either meets with the patients during their visits or calls during follow-up to further discuss their needs and existing supports. The list of the available 600 resources is maintained on a wiki page, making it free and easy to update.
Patients have an average of two major identifiable social needs. The three issues most commonly addressed by the program are lack of preventive care such as mammograms and diabetes screenings, low adherence to follow-up appointments, and food insecurity.
In the first three years, the MSAs identified 2,267 social needs and served 852 patients.
Program equips medical students with tools to change the health care landscape
Given the changing nature of care delivery, future physicians must be equipped to work in collaboration with an expanded care team and address both clinical and non-clinical patient challenges. A majority of student participants agreed that the program provided them with three educational opportunities 1) preclinical patient interaction; 2) exposure to the social determinants of health and population health management; and 3) participation in an interdisciplinary team.
After completing the program, one MSA noted, "[Patients] just need someone to be on their side, to be on their team and take that extra step.''
How to build the business case for community partnership
To be successful, population health programs must invest heavily in partnerships with local organizations and health departments.
Download our white paper to learn how to develop and leverage these partnerships to address the root causes of local health challenges. See page 12 for our complete community health initiatives metric pick list.