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February 24, 2017

From guard rails to food banks: How Geisinger and Kaiser are rethinking what 'health care' means

Daily Briefing

    To help patients with chronic conditions like diabetes, health systems are targeting social determinants of health, such as nutrition and housing, Jayne O'Donnell reports for USA Today.

    Geisinger's food prescription program

    For instance, Geisinger Health System's Andrea Feinberg—an internal medicine physician and "clinical program champion"—helped the system develop a food prescription program aimed at improving diabetes patients' access to nutritious food.

    If left unchecked, Feinberg believes that diabetes care will "cripple our health care system," once the cost of insulin, amputations, kidney disease, and stroke are considered. But she pointed out that about 95 percent of diabetes cases in the United States are Type 2—which Fienberg considers a "reversible disease."

    Geisinger's food program aims to help those patients. Through the program—now in its pilot stage— Geisinger provides participants no-cost healthy groceries every week. So far, all five of the pilot participants have lost weight, reduced their body mass index, cut back their medication use, reduced their cholesterol, and improved their hemoglobin A1C levels, according to Feinberg.

    The system plans to expand the program to more than 50 of its sickest and highest-cost diabetes patients in March, O'Donnell reports.

    Kaiser Permanente zeros in on social factors

    Meanwhile, Nirav Shah, SVP and COO for clinical operations at Kaiser Permanente's Southern California division, said the organization is working with Health Leads, a not-for-profit, to "fundamentally redefine what counts as health care."

    The program focuses on meeting the social care needs of patients who account for a disproportionate amount of Kaiser's health care spending. Roughly 1 percent of Kaiser members account for nearly 25 percent of Kaiser's total medical spending, Shah said in a recent article in the New England Journal of Medicine.

    To help these patients, Kaiser employees contact them at home to ask whether they need assistance with things like food, housing, bill payments, and transportation—social factors where hospitals typically do not focus their attention, Shah said.

    In one case, Kaiser helped an older woman who had suffered repeated falls by working with a tenants' rights group to get a $60 railing installed at her apartment. "We call her back every few weeks and she says, 'Thanks so much,'" Shah said.

    HealthLeads CMO Damon Francis described efforts to address the social factors that lead to recurring need for medical treatment as "whole person care."


    According to O'Donnell, organizations such as Geisinger and Kaiser are leading the charge on addressing patients' social needs, in part because their profits aren't based on the number of patient visits and treatments. Rather, their incentives are more closely aligned "to the health of their patients," said Joshua Sharfstein, a pediatrician who was a former secretary of health for Maryland.

    There are other potential cost savings and sources of funding, O'Donnell writes. For the food program, for instance, Geisinger partnered with the Central Pennsylvania Food Bank and used a $10,000 grant from Weis Markets to launch the pilot.

    O'Donnell also points to funding for housing, which she writes is "key to health." She explains that while Medicaid can't fund room and board, Medicaid funding can be used to help people find housing and move in. According to Francis, that means that local governments that previously covered those services can fund rent instead.

    CMS also recently launched the Accountable Health Communities Model, a grant program aimed at testing how addressing social determinants of health affects beneficiaries' health. According to USA Today, the program will generate data that could lead to permanent reimbursement for such services (O'Donnell, USA Today, 2/17; Accountable Health Communities Model fact sheet, accessed 2/21).

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