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12 Things Healthcare Must Achieve Flash Video Series – Manage Social Determinants of Health

by Julius Heil, President and CEO, Intalere

During a recent presentation at Intermountain Healthcare, someone shared the phrase, “ZIP code is more important than genetic code,” when referencing what is now generally known as population health management. Healthcare providers must understand that they need a strategy to solve health problems before they show up in their emergency rooms, and that impacts made in the communities they service affect costs of healthcare delivery. Research has shown that initiatives focused on vulnerable populations in underserved communities significantly decrease ER visits.

Each year, through submissions to our Intalere Healthcare Achievement Awards program, we are seeing simple, yet effective community initiatives that are getting people more involved in their healthcare and general well-being. 

  • In partnership with a local non-profit food bank, Advance Community Health in Raleigh, N.C., launched a Mobile Food Market to provide increased access to healthy food, with an additional focus on measuring the health and behavioral outcomes of patients with diabetes or pre-diabetes having access to healthier food options.

An average of 33.5 people participated each week over the course of the 26-week program. More than 30,000 lbs. of healthy and fresh food was distributed in more than 1,740 grocery bags. The majority of participants completed the program feeling healthier, more confident in managing their diabetes, more familiar with healthy foods and better able to incorporate healthy foods into their daily lives.

  • Highlands Hospital in suburban Pittsburgh, Pa., developed and implemented the IM WELL Program (Integrative Medicine – Women Excelling Living Life). The program incorporates three domains of women’s health: nutritional, physical and mental. The program is open to all women ages 14 and older, and targets women who are uninsured or underinsured. In addition to core group classes, the program has a care coordinator who helps navigate women to appropriate community resources and services. The core group classes are taught by a licensed dietitian, a behavioral therapist, a certified integrative therapy nurse specialist, a certified diabetes educator and an exercise specialist.

The results of the program: 289 interactions with women, 780 phone calls, 400 health text messages answered, 391 follow-up appointments made for specialized health concerns and 50 interventions by the case manager. As a result of the program, 100% of the women met IM goals, 100% exercised at least three times per week, 58% were able to meet nutrition goals and 48% were able to meet water intake goals.

The mindset of caring only for individual patients in physicians’ waiting rooms must become a thing of the past. Hospitals are no longer concerned only with people in their beds. It’s not just about the sick in the era of pay for performance. Not only is population health the right thing to do, it’s the smart thing to do. The objective is to keep everyone healthy, and to do that requires healthcare providers to pay close attention to defined populations and coordinate their care.

Check out the latest video, Manage Social Determinants of Health, in our Flash Series and stay tuned in the coming weeks for more posts and videos about 12 Things Healthcare Must Achieve.

You can also download the executive briefing at Intalere.com.