When community-based organizations are already meeting social needs, healthcare organizations should build partnerships rather than building their own programs.
Health systems and hospitals across the country are forming partnerships to help address social determinants of health (SDOH) in the communities they serve.
Social determinants of health such as housing, food security, and transportation can have a pivotal impact on the physical and mental health of patients. By making direct investments in initiatives designed to address SDOHs and working with community partners, healthcare organizations can improve patient health in profound ways beyond the traditional provision of medical services.
For healthcare organizations, there are specific circumstances when forming partnerships is preferred over making direct investments to meet SDOH needs, says Adam Myers, MD, chief of population health and director of Cleveland Clinic Community Care at Cleveland Clinic in Ohio.
"Partnerships are effective anytime when there is work already being started or when work that hasn't been started would best be done collaboratively," he says.
Health systems and hospitals should resist the temptation to create a "de novo project" aimed at any SDOH, Myers says. "Rather than creating our own program, we often need to be learning, listening, and standing beside existing community organizations to determine what we can do to support them and create synergy."
Trust is the indispensable ingredient for a successful SDOH partnership, he says. "It has to be built on trust, and trust is only possible through true listening, seeking to understand each other's felt needs, and partnering in ways that strengthen community-based organizations and help meet community needs."
Humility is also an essential factor when working with community-based organizations (CBOs), says Annette Fetchko, who was the regional director of the Center for Inclusion Health at Pittsburgh-based Allegheny Health Network until recently and currently serves as CEO of the Bethlehem Haven homeless shelter in Pittsburgh. "Health systems have always felt that we have the answer. However, we are learning that we need to understand what is needed from the community's perspective and the CBO's perspective. That has been essential in forging relationships with CBOs."
Barbara Gray, MBA, senior vice president for social determinants of health at AHN's corporate parent, Pittsburgh-based Highmark Health, offers several pieces of advice to healthcare organizations seeking to forge SDOH partnerships.
"Take the time to invest in the relationship. Understand each other's goals and objectives. Articulate the guiding principles under which you are going to operate as a partnership. Be flexible. Recognize what each other brings to the table. And be open to learn from each other and transform—not only the program but also the way you see your role in serving your population," Gray says.
Food security partnerships
The opening of two Healthy Food Centers on AHN hospital campuses is a prime example of effective SDOH partnerships, Fetchko says.
The first step was identifying the need and recognizing the benefits of establishing partnerships, she says. "When we began to screen at the system level for food insecurity and evaluated the data, we clearly recognized that there was a significant social gap in access to nutritious food. As a health system, we also recognized that we were not the experts in identifying access to nutritious food and distribution of those foods. Organizations in our communities were far better experts."
AHN opened the health system's first Healthy Food Center in April 2018 at the West Penn Hospital campus in Bloomfield, Pennsylvania. The second Healthy Food Center opened in January at Allegheny General Hospital in the North Side neighborhood of Pittsburgh.
Each Healthy Food Center is managed by a registered dietician and stocked with nutritious dried, refrigerated, and frozen foods. AHN clinicians can make patient referrals to the Healthy Food Centers through the health system's electronic medical record, Epic. CBOs can make referrals to the Healthy Food Centers via a scanned document or fax.
Making referrals through Epic helps ensure that referred patients don't fall through the cracks, Fetchko says. "If a referred individual has not engaged with the Healthy Food Center, we have a process where we will do outreach to that individual. We ask whether they plan on making an appointment, whether they understand the concepts of the Healthy Food Center, and whether they need transportation assistance because we set up a partnership with a local nonprofit organization to provide transportation."
As of mid-April, there had been 2,200 referrals to the Healthy Food Centers, providing meals to more than 6,700 people, she says.
The cost of operating one of the Healthy Food Centers, which is funded by AHN, ranges from $175,000 to $200,000 annually inclusive of personnel costs. However, community partnerships play a pivotal role at the facilities, Fetchko says. "As we identified the needs of community residents, we worked with CBOs such as Greater Pittsburgh Community Food Bank and 412 Food Rescue to determine how to source, distribute, and provide access to nutritious food. We leveraged the expertise of each organization."
The food bank helped AHN convene several CBOs to learn about the community's food needs as well as about food distribution and sourcing, Fetchko says. And 412 Food Rescue, which is a nonprofit organization that sources food that would otherwise be thrown away, makes a "very large donation" to the Healthy Food Centers, she says.
Other significant CBO partnerships for the Healthy Food Centers include the Bloomfield Development Corporation, which hosts a farmers' market, and The Food Trust based in Philadelphia.
The Food Trust provides "food bucks" to the Healthy Food Centers that can be redeemed at participating corner stores, supermarkets, farmers' markets, and Green Grocers for fresh produce, says Senior Healthy Food Center Manager Colleen Ereditario, MPH, RD. "Since July 2018, $15,000 worth of coupons have been redeemed from our Healthy Food Center clients alone. The clients report that, as a result, they have increased fruit and vegetable intakes and access that they would not have had otherwise."
Early longitudinal data shows the Healthy Food Centers are having a positive impact on clinical metrics, Fetchko says. "Because the first Healthy Food Center has been open for more than 18 months, we can look to see whether we have had a positive impact on hemoglobin A1c, cholesterol, and high blood pressure. As part of the longitudinal study for A1c, we have seen a 20% reduction in A1c over a six-month period and sustained that over a nine-month period."
Although no single organization can meet the emergency food needs resulting from the COVID-19 pandemic, the Healthy Food Centers have risen to the challenge, Fetchko says. "The Healthy Food Centers have continued to maintain daily access to nutritious food sources by implementing a modified process whereby individuals can receive bags of nutritious food at the centers that are packaged and distributed by center staff. Included in these bags are recipes to support meal preparation as well as nutrition information."
The Healthy Food Centers have also added community-based services during the pandemic, she says. "Our team has implemented a process to distribute emergency food boxes via the centers as well as home delivery for those who are quarantined or self-isolating due to health risks associated with the pandemic. These individuals are not able to access the broader drive-up food distribution, so the Healthy Food Centers' ability to try to serve these individuals is critical."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Pittsburgh-based Allegheny Health Network operates two Healthy Food Centers in partnership with several community-based organizations.
AHN clinicians can refer patients to the Healthy Food Centers, which feature nutritious dried, refrigerated, and frozen foods.
The Healthy Food Centers have had a significant impact on clinical outcomes. For example, the facilities have been linked to a positive impact on patients' hemoglobin A1c levels.