Americans want change. The COVID-19 pandemic and resulting economic downturn have highlighted a glaring fact – despite access to greater healthcare technology and resources, the U.S. falls behind other nations in providing its citizens access to quality, affordable health care.
In fact, according to a report just released by The Commonwealth Fund, the United States ranks last on a ranking of healthcare systems among 11 of the wealthiest countries in the world, all while spending the highest percentage of its GDP on healthcare. The United States’ health care spending--an estimated $11,000 per person per year--is twice what other developed nations spend and is the highest per capita of any other developed nation in the world. Despite this level of investment, the U.S. fares worse in key health metrics, such as life expectancy and maternal and infant mortality.
According to the Organization for Economic Co-operation and Development (OECD), the U.S. ranks 37th among OECD nations only ahead of Turkey for its investment in social services. Researchers have begun to draw a linkage between that investment disparity and health outcomes, noting that “states with higher ratios of social to health spending had better health outcomes one and two years later.”
The COVID-19 crisis has shown us more than ever before just how critical local healthcare is in the U.S. Our zip codes are still the top determinant of whether and how we live and die.
It is imperative that we challenge this status quo in our healthcare and social services systems to deliver high quality care and finally truly address disparities in health and care. Data and technology are playing an increasingly prominent role in improving quality but are often missing connectivity with other critical activities such as clinical interventions and addressing the social determinants of health. By bridging that divide with greater collaboration and partnership at the local level, we can use data to address these inequities.
What does this collaboration look like in action?
In Detroit, Michigan, the Population Health Outcomes and Information Exchange, known as the PHOENIX Program is a great example of what can result from the integration of clinical and social determinants of health data to identify biological risk factors (e.g., blood pressure, hemoglobin A1c) and chronic disease “Hot Spots.” The process begins with the Michigan Health Information Network (MiHIN), a statewide health information exchange, sharing clinical data, including ICD-10 diagnosis codes, laboratory test results, vital signs, medications, body mass index and social history. This data is then integrated with social determinants of health information from administrative datasets that characterize the same geographic areas. The pooled data is then used to identify populations with risk factors and chronic disease burdens and targets those at risk with community programs that focus on upstream and preventive resources.
The PHOENIX program is a good example of what happens when you integrate the resources of two entities that are critical to the transformation and improvement of health at a local level: regional health improvement collaboratives (RHICs) and regional and statewide health information exchanges (HIEs).
RHICs are nonprofit organizations that include consumers, healthcare providers, payers, and purchasers of healthcare who function as trusted, neutral conveners that help identify opportunities and implement strategies that improve the health and healthcare of their communities. HIEs are state and local entities, either nonprofit organizations or state agencies, which manage and provide for the secure digital exchange of health data for hospitals, healthcare providers, and other participants. With multistakeholder governance models, they work to improve care coordination and care management across healthcare systems and communities, enable more informed clinical decisions, and reduce hospital readmissions and other preventable expenditures such as unnecessary or duplicative tests and procedures.
By working together, RHICs and HIEs offer the combined resources, knowledge, and assets to respond to changing needs in the health improvement landscape, namely the need for health data, technology, and trusted relationships to further advance health access, quality, affordability, and equity for all.
In partnership, these organizations are well equipped to effectively address the social determinants of health through data-driven approaches that focus on local needs, thereby helping communities better integrate healthcare, social services, and critical supports that will ultimately improve costs and outcomes.
While these entities often worked in coordination in their communities, they have rarely had national representation that connects them with federal policy goals. With the establishment of Civitas Networks for Health on October 1, 2021, that will change. Civitas Networks for Health is a new organization that aims to capitalize on the clear synergies between RHICs and HIEs, and other similar health data-focused organizations. We are uniting to launch a new paradigm, elevating the work of local healthcare innovators, amplifying their voices at the national level, supporting the exchange of resources and ideas among their programs, and ultimately informing practice and policy at the federal, state, and local levels. By working in trust across stakeholder groups and sectors and with the communities we represent, we can better harness data and technology to not just shed light on the challenges we face across our healthcare system but to point us toward solutions.
As we emerge from the pandemic, we are seeing renewed energy across a wide range of jurisdictions for the role of community health leaders to advance local transformation in line with national goals for healthcare quality, cost, and equity. Civitas Networks for Health will be a key driver of connecting, informing and supporting leaders from multiple sectors who are joining forces to drive improvement for their communities. We see the future of healthcare as one in which we all have a stake in bringing about the successful transformation. Through locally informed, data-driven innovation, that future is now.
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Lisa Bari, MBA, MPH, is the interim chief executive officer for Civitas Networks for Health. As of October 1, 2021, Civitas Networks for Health is a new nonprofit organization formed through the affiliation of the Network for Regional Healthcare Improvement (NRHI) and Strategic Health Information Exchange Collaborative (SHIEC) that aims to change the current status quo in healthcare. Craig Brammer is the CEO of the Network for Regional Healthcare Improvement (NRHI) and president and CEO of The Health Collaborative, a regional health improvement collaborative in Cincinnati.
