Care Transformation Center Blog

The illnesses that never happen: A pathway to prevention

by Akram Boutros, MD, president and CEO of The MetroHealth System, and Robert Musslewhite, chairman and CEO of The Advisory Board Company

In health care policy circles we often focus too much on Washington and not enough on the promising innovations already happening on the ground, in our communities.

Many locally-driven innovations are quietly transforming the lives of patients by better integrating care and even preventing sickness in communities across the country.

In Greater Cleveland alone, we have ample stories to tell.

An 11-year-old girl with asthma visited the emergency room 74 times in a single year. Now, her attacks have all but ended.

A young boy lived in a home with lead and the risk of nerve damage, kidney problems, and permanently reduced IQ. Today, he's healthy, thriving at school, and living without that threat.

A senior citizen who had struggled to control her diabetes and hypertension risked even greater health problems. Now, she’s making steady progress through a healthier diet.

What changed?

First and foremost, working together, we decided to tackle social determinants of health—which cause 80 or 90 percent of all health problems—and started working in partnership with local non-profits, businesses, and government.

We found innovative ways to improve our patients' health and the well-being of the broader community.

  • In the city's Brooklyn Centre neighborhood, we removed mold and lead from homes to better control asthma and help kids develop.

  • We opened an on-site food pantry, where low-income patients with "food prescriptions" can pick up nutritious food to help control their hypertension, diabetes, and obesity.

  • We also put a special focus on connecting low-income pregnant women and frail elderly populations to social services.

There is no one-size-fits-all solution to addressing the social hazards and challenges our patients face beyond our walls. However, working in these partnerships does allow us to better identify and develop sustainable, positive results. Block-by-block, neighborhood-by-neighborhood, and, community-by-community they are being overcome.

This work is the foundation of a health care system that meets patients where they are to address issues before they escalate into crisis. Done successfully, we can head off some of the biggest drivers of health care spending.

Regardless of what happens in Washington, addressing the social determinants of health is the future of health care. More and more, communities will evaluate their hospitals through the health and wellbeing of the people they serve. By 2019, Medicare will virtually require hospitals to invest in keeping people healthy. Treating patients once they fall ill simply won't be enough. In this context, disease prevention, already a moral imperative, becomes a business necessity.

MetroHealth may have been an early adopter, but it is not alone. Transforming health outcomes requires a coordinated effort to tackle contributing factors like transportation, housing, environmental issues, and access to healthy food. MetroHealth and the other BUILD participants are forging with Advisory Board a best-practice playbook for health systems to partner with local businesses and nonprofits to address community health, and this playbook will increasingly be applied across the nation.

Whatever happens in Washington, D.C., policymakers should take note of the strides we've made in improving the health and wellness of our patients through community partnership and do what they can to encourage others to forge partnerships in their own communities. Their residents and patients are depending on them.



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.

Download Now



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