Atlanta Collaborative ‘Inverting the Burden’ to Address Inequities

June 26, 2021
Atlanta Regional Collaborative for Health Improvement deploys community health workers at FQHC Mercy Care and Grady, a local safety net hospital

The Atlanta Regional Collaborative for Health Improvement (ARCHI) is seeking to place the burden of addressing racism and other inequities on institutions rather than individuals.

During a recent webinar, ARCHI’s leaders described working on these issues through Community Resource Hubs serving the immediate needs of patients at Grady Health System and Mercy Care Atlanta.

 The webinar was sponsored by the National Center for Complex Health and Social Needs, an initiative of the Camden Coalition of Healthcare Providers in New Jersey.

Kathryn Lawler, executive director of ARCHI, said the collaborative includes more than 110 organizations aligned around commitment to improving health, not only by focusing on the social determinants of health, but by developing a deeper understanding and knowledge of the historic policies and practices and prejudices that have created lasting inequities. “We are committed to meeting the needs of today in our community, but also doing the systems change work so that we have a fundamental shift in healthcare outcomes that can last many generations to come., she said, adding that ARCHI’s work in the area of complex care is critical to their overall strategy of driving health and racial equity in the community.

“Inverting the burden” is an approach to achieving health equity by placing the burden of addressing racism and other inequities on institutions rather than individuals. It includes techniques for addressing the “downstream” immediate needs of complex care patients, the “midstream” supply of affordable housing, quality jobs, and insurance coverage, and the “upstream” root causes of systemic racism. 

One of the ways that ARCHI has begun to operationalize the concept of inverting the burden in Atlanta is through community resource hubs, said Meredith Swartz, a consultant to ARCHI. The organization has worked with its partners to establish a network of health systems and service providers that seeks to invert the burden of navigation from the patient to the system itself. It’s founded on two principles: meeting people where they are and placing them at the center of a system that coordinates care around them, she said. “We have two healthcare sites, Mercy Care, a local FQHC, and Grady, a local safety net hospital,” she said. “Community health workers within those systems identify and work with patients who have chronic medical conditions as well as non-clinical needs that are preventing them from achieving their health goals.”

The community health workers work with patients to determine the personal needs and goals and then coach them through the process of accessing services in the network and also make referrals to the partner organizations while continuing to tie that work back to their health. This involves bidirectional data sharing between the health systems and agencies, warm to hot handoffs based on relationships that have been built within the network, coaching, a clear governance structure and aligned incentives.

 “We worked with patients at both health systems in the design phase to determine what social needs were most in the way of them achieving their health goals,” Swartz said. “At the top of the list were safe and healthy housing, access to nutritious food, and transportation to access the services that they need. Our partner network comes together as a full group every month. The group attributes its success so far in large part to the relationships built within the network. “We also know that they want to keep this momentum going. It's working for them and their clients and they all continue to be willing to invest the time and energy,” she added.

During the webinar, Jasmine, a community health worker at Mercy Care Atlanta, said she uses the same measure of success for her clients that she uses for herself. “You might feel like you're failing right now because all of these things happen, but successes are when you're getting exactly what you need on the day that you need it,” she said. “With my clients, it's moment by moment by looking for the bright spots. With my clients, I'm super optimistic, but at the same time realizing that there's a reality that people are dealing with, right? Certainly we can say the person who was housed, who came into the Community Resource Hub, and they need housing, and they got their paperwork in order, this person is successful. But so is the person who comes in and doesn't have any of those things together — they might be successful because they came into the Community Resource Hub, and they said, ‘I need help with this issue,’ because that person could have chosen to just give up that day or could have chosen to end their life that day, instead of seeking help. If we have this measure of success with more grace, it opens things up. That optimistic mindset is contagious.”

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