I believe we create false distinctions between healthcare and non-healthcare services. Recently I read with great interest a study that explored this issue by Vickery, et al, Cross-Sector Service Use Among High Health Care Utilizers in Minnesota After Medicaid Expansion in Health Affairs. The authors reviewed the service utilization of enrollees across the domains of healthcare, housing, criminal justice, human resource needs such as food support and any other case management. They compared two groups, one identified as high utilizers of healthcare services and the other as non-high utilizers. Regardless of the domain reviewed, if one had higher healthcare utilization then higher utilization was seen in each of the other areas as well.
The resource needs and issues of those we serve are interdependent. We have essentially built our social services in silos that do not result in enhanced overall health and well-being. Focusing on just the service needed and how best to provide it, versus centering our focus on the human being and solving their cross-functional needs, will lead to our present results not changing. Social services and healthcare delivery effectiveness will require a networked model of care.
One methodology to deliver on our aspirations is to better connect needs. For example, if we identify a person that needs housing, there is a high likelihood they require other assistance. As they are also likely to be higher utilizers of healthcare, coordinating such resources and sharing knowledge between organizations will enhance the ability of all involved to deliver needed services. Think about a time when individuals who are about to leave our criminal justice systems trigger a notice to the other service organizations, thus allowing them to reach out and identify needs. Repeated emergency room visits are a sign that other services are required, thus automatic referrals could be implemented.
How will this happen? In every community where all these services are provided, there needs to be a leadership structure in place that is vested in such resource coordination. Though everyone has good intentions as they work within their area of expertise, a “coordination catalyst” is required. We speak to the ideals of accountable care organizations, the quadruple aim and population health, but we only do so within our respective sectors. Total accountable care, Total population health and Complete well-being represents aspirations that encompass all domains. High tide does raise all ships.
Who will step up and lead such initiatives? I am sure we all very quickly believe it is someone other than ourselves. Is it? Let us embrace the totality of our situation and address focus on the commonalities of our callings. Starting from such a holistic premise will allow ourselves to advocate more wholly for those we serve, not by having to provide all needed services, but by making the connections and partnerships. Only through such coordination of purpose, actions and operational focus will we succeed in our respective missions. The solutions are there, the challenge is for us to see them through a completely different lens.