Tag Archives: Social Determinants of Health

John D. Bower School of Population Health

JDB LogoI’m honored to have been appointed as Graduate Faculty at the John D. Bower School of Population Health at the University of Mississippi Medical Center.

The School is one of the few schools of Population Health in the nation and “their mission is to educate leaders who will transform health care delivery and the health of Mississippians.

This really resonated with me as I had previously done work in Mississippi when Specialty Disease Management Services Inc. (SDM) was involved in the Medicaid disease management initiative as a subcontractor to McKesson Health Solutions.  SDM provided on the ground RNs and community care coordinators located throughout the state seeking to improve the health and care for Medicaid beneficiaries with asthma, diabetes heart failure and COPD. I also have in-laws in Leland, Mississippi in the heart of the Delta.

beech,-bettina1The school is led by Dr. Bettina Beech, their Dean, who is a dynamo building the school and truly working to embed the schools expertise into the state by getting involved in programs to leverage population health in an effort to improve the health of all Mississippians.  Her areas of scientific inquiry focus on the role of nutritional factors in the primary and secondary prevention of obesity and type 2 diabetes, with a particular focus on child health disparities.

The School has three departments, Data Science, Population Health Science and Preventive Medicine.  Offering an MS/PhD in Biostatistics and Data Science, an MS/PhD in Population Health Science and and their newly launched Executive MS in Population Health Management.

This semester I taught a course on ACO’s in their Executive Masters Program.

bower,-johnDiscussing the School of Population Health would be incomplete without mentioning John D. Bower, MD.  Dr. Bower was instrumental in establishing care for kidney dialysis and the federal legislation(H.R. 1) that made persons with end-stage renal disease eligible for Medicare. This was population health at its finest, embodying clinical practice,  healthcare system reform, program delivery and policy.  You can learn more about Dr. Bower and the work his foundation does here.

 

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Running to the Ball: the Shiny Object of Social Determinants of Health

Social Determinants of Health (SDoH) are all the rage, we see it discussed by hospitals, physicians, IT companies, health plans, academia, community non-profits, government, and the list goes on and on.  It’s amazing how rapidly addressing SDoH has sprung up as “the solution”, and it may in fact be.  But before we get too excited we need to consider that approaches to solve SDoH need to be operationalized and who does what, how the approaches are overseen, and accountability will make or break the outcomes.

The current behavior of the majority of sectors reminds me of a kid’s soccer game.  If Soccer Kidsyou’ve ever watched one you’ve no doubt seen a mass of children tightly arranged around the ball, each one trying to kick it, while 98% of the field is wide open.

Effective teams spread out, each one playing their role, in their assigned space while being held accountable.

If we’re not careful, our current efforts to address the Social Determinants of Health in each of our communities will experience the same thing, a promising approach will be replaced by the next healthcare shiny object; not because the concept was wrong, but because the execution was flawed.

So how should these efforts be organized, who should be in charge and who should be Walking Dogaccountable for what?  Here’s an interesting photo to ponder as an example, it’s used quite often in presentations about obesity, behavior change and in just a few instances, Social Determinants of Health.

Audience –  “Ha ha, that’s the lazy American, just look at them driving and walking the dog, they are the source of our obesity problem. We need behavior change. They need to get out of that car and walk.”

And in response to the clamor, in rushes our current healthcare system “get out of our way, we have come to solve the obesity problem, we are going to do it by addressing the new-fangled shiny object, Social Determinants of Health.”

And the overall system say’s “fine, let’s hold the hospitals and doctors accountable for the obesity problem by establishing quality measures and value-based reimbursement and penalize them when their patients are overweight, or our health measures don’t improve.”

And run towards the problem we all go.

But, perhaps the healthcare system shouldn’t run in so fast or forcefully to the ball, perhaps the healthcare system shouldn’t be the one to kick it at all.

A better response might be “Wait are you/we sure?  Can we really fix this? I don’t see any sidewalks? Is the neighborhood safe?” Or the myriad of other issues associated with Social Determinants of Health.

As Bones, Doctor McCoy might say, “ Dammit Jim, I’m a Doctor, not a sidewalk builder, Bonesengineer, grocer, community non-profit, housing authority or police officer.”

And if it’s not the healthcare system that can solve these problems, perhaps, someone else should lead these effort’s, resulting in the healthcare system focusing on their unique and needed areas of expertise.  Playing their role on the field as a team member.

To solve the SDoH, the most critical role the healthcare system should be addressing is the oft forgotten Triple Aim concept of “lowering the costs of healthcare”.   It’s estimated that 30% or maybe more of healthcare is waste, unnecessary, fraud etc.,  that’s a meager trillion dollars that we could and need to free up to provide funds to the groups building the sidewalks, opening grocery stores, creating safe neighborhoods, improving education and the rest of the issues we know so well.  Addressing the SDoH should not require new funds, the money is there already, it just needs to be released.

And when it comes to focus and accountability, I’m not just picking on the healthcare system. Those in government, non-profits, IT etc., need to play a role, by working in their unique space, on the field.  And in that role, they too need to be held accountable.  Just as the healthcare system has waste that needs to be freed up or eliminated, many community organizations and government players have been working for years in their communities yet the statistics on health status are no better or getting worse.  What benefit has the community gotten from those services? And in the  IT world many companies have promised interoperability, increased efficiency, improved outcomes, yet we still haven’t seen it. Unfortunately, the list of poorly executed systems crosses all players.

It’s time to organize a broad-based coalition, not led by the healthcare system, but led by the community with the healthcare system at the table (and not the biggest vote either), each sector bringing their expertise, playing their position and being held accountable.  If we all run to kick the ball, try to be the coach, go after that shiny object called Social Determinants of Health, we’ll end up right where we are; just older, having squandered another goal scoring opportunity.

 

 

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Where is the Elon Musk of Healthcare?

In April of this year I presented at the University of Mississippi Center , School of FG spacex,-moonshotsanddiabetesPopulation Health. A description of that presentation is on LinkedIn:

SpaceX, Moonshots and Diabetes in Mississippi

 

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PopHealth Week Now Available on iTunes

You can now download all of the episodes of PopHealth Week on iTunes. Future episodes will be added as they are recorded.  Please have a listen, subscribe and rate the show.

Here is the link:

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PopHealth Week on iTunes

 

PopHealth Week is a production of Health Innovation Media.

 

 

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Webinar on SDoH and Geospatial Data

I recently the pleasure of participating in a Webinar with Joe Warbington of Qlik moderated by Mike Perkowski on

Visualizing population health: How geospatial and social determinant data informs preventive care

 

You can watch it here..

 

 

 

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