Health care organizations today face many pressures: Provide better outcomes and patient experiences. Manage the health of entire populations. Reduce disparities. Do it all as cost-effectively as possible.
Safety net organizations — which provide a significant amount of care to low-income, uninsured, and vulnerable people — have been working on these objectives for decades. At Rancho Los Amigos National Rehabilitation Center in Downey, California, we’ve learned many lessons that we believe are valuable to the wider health care world. Population management is complex, and organizations must tailor their approach to the unique needs of their patients. But there are some recommendations that any organization can use to improve population health:
- Give power to program managers and care providers — Make sure the team members who develop programming and oversee care have the authority to make decisions they deem necessary. If you ask, they will tell you how to best meet your population management goals. Too often, no one asks. An organization then develops an initiative that fails. Those most familiar with your patients’ needs could have told you it wasn’t going to work. Respect their experience, and don't waste precious time or resources.
- Include patients in program development — Engage patients in decision making, get their program design input, and then use it. If the populations we serve do not agree with what we’re trying to do, or don’t trust us, our population management efforts can’t be successful. For example, safety net organizations have historically cared for underserved populations. Our patients are too often at the end stage of a disease process because they were unable to access care in a timely manner — often because of fear or lack of knowledge about preventative or primary care. When we don’t invest the time in understanding people and earning their trust, we make it much more difficult to develop the kinds of partnerships that are essential to improve population health.
- Engage community partners — Safety net organizations have always had limited resources, so we have to be creative, efficient, and skilled at making the most out of very little. Unlike many other health care systems, we also learned a long time ago that we have to work closely with others in the community to be successful. Safety net organizations often learn to be resourceful in identifying ways to leverage community partners and resources, including health plans, churches, public social service agencies, city councils, and grant funding. Organizations and agencies that have an impact on the social determinants of health should be our allies.
Rancho Los Amigos National Rehabilitation Center (Downey, California)
A few years ago, Rancho Los Amigos social workers worked with the community to help out two young men with quadriplegia who had limited social and family support.
Both young men required total care after separate traumatic events, and had limited social or family support. To help them make the most of what they had, social workers came up with the creative idea to pool some of their resources. By working with a number of agencies and programs to connect them to the right resources, the patients were able to share an apartment and a caregiver, and get social security disability benefits, furnishings, food, and necessary equipment and supplies.
As a result of a true community effort, these two young men are doing well — they haven’t been hospitalized in two years, live in safe housing, attend regular doctor’s appointments. They are thriving as independently as possible in the least restrictive environment with sustainable support.
This kind of situation is not easy to negotiate, but it is an example of what we can accomplish if we work together with our patients, health care systems, and community partners. It taught us a great deal about what’s possible when we are resourceful, and work closely with others for the good of our patients.
You may also be interested in:
WIHI: Safety Net Hospitals: Untold Stories of Quality Transformation
A Primer on Defining the Triple Aim