Years into the U.S. healthcare system’s journey around health equity, Jessica Bylander, a deputy editor and correspondent at Health Affairs, is reporting on innovative approaches that healthcare leaders are taking to tackling the social determinants of health challenges facing their patients and communities.
In an article in the January issue of Health Affairs, Bylander reports on several promising initiatives. One in Cleveland involves eleven different organizations—three health systems, five health insurers, two foundations, and the Western Reserve Area Agency on Aging—that are collaborating on an innovative program called the Nutrition Solution, which provides meals tailored to individual patients’ nutritional needs. Those leaders are leveraging a model called the Collaborative Approach to Public Goods Investing, or CAPGI, which is being piloted in several cities across the U.S. to fund a variety of health equity interventions, from COVID-19 vaccine access to complex case management for families with behavioral health-related social needs.
And she quotes Lauren Taylor, an assistant professor in the Department of Population Health at the NYU Grossman School of Medicine in New York City and co-creator of the CAPGI model, who says that, ““Rather than kind of rehashing the debate about should health systems pay for it, should community organizations pay for it, should health insurers pay for it, this was a way to take seriously what we all know, which is that many players benefit simultaneously, and as a result, many players should pay some minority amount.”
Nutrition Solution is targeted at Medicaid-eligible people with heart disease, hypertension, diabetes, or kidney disease (or some combination), age fifty or older, who are food insecure and were admitted to the hospital for treatment and discharged home. Participants receive ten meals a week developed by a dietitian for their medical condition. They also get nutrition education information and an option to do “wellness calls.” The program is designed to decrease hospital readmissions, reduce health care costs, and address food insecurity and social isolation.
The article goes on to analyze why Nutrition Solution has been an effective health equity instrument, when some previous efforts haven’t panned out. For one thing, the program has targeted patients with at least two key chronic conditions. And what has been interesting has been the documented savings: for example, patients of the MetroHealth health system had a cost savings of $1,532 per participant per month, more than 70 percent of which was attributed to the intervention. As a result, Bylander reports, “The health system has doubled the number of patients who will be served in the second cycle of the program, from thirty patients in the first cycle to sixty-five in the second cycle, and hopes to make it a permanent offering. Matlack [Kristen Matlack, Community Health Advocacy Initiative manager at MetroHealth’s Institute for H.O.P.E., which screens for and addresses social determinants of health for the health system] notes that MetroHealth will likely opt to partner one-on-one with collaborators from this process instead of pursuing the CAPGI process again.”
