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Page 8B— COLORADO REAL ESTATE JOURNAL — March 4-March 17, 2015
W e’ve heard a lot
in recent years
about the move
from campus centric to more
decentralized ambulatory
networks, but why? How about
the harsh reality of death by
ZIP code? Evidence has shown
that life spans can be directly
correlated with socioeconomic
status. Nonprofit health care
systems in particular historically
have been safe havens for the
underprivileged. With the
Affordable Care Act, these
health care systems are now
finding themselves even more
accountable for the health of
the communities they serve in
spite of more and more limited
resources.
Stephen Covey’s “Seven Habits
of Highly Effective People” told
us 25 years ago about focusing
on our circle of influence, not
our circle of control (concern).
He defines proactive as “being
responsible for our lives …
and how our behavior is a
function of our decisions not
our conditions ... Proactive
people focus on issues within
their circle of influence. They
work on things that they can do
something about.”
The nature of their energy in
doing this is positive, enlarging
and magnifying. By focusing
less on things that we cannot
control, we create more
ability to increase our circle of
influence. While Covey’s book
was targeting individuals, I think
it also applies to organizations.
The traditional hospital
campus is now giving way
to a more diversified system
of delivery. Health care
administrators are designing
from their property line out
and becoming community
extroverts. There still is a need
for specialized services and
high-acuity care that can be
managed in a very controlled
environment; but at the
other end of the community
spectrum, health care systems
are seeking partnerships with
other community institutions
and connections to the people
they serve in order to promote
wellness.
Health care systems are
seeking ways to perfect their
community care management,
but it’s daunting. They are
seeking ways to expand their
influence without extending
their current resources. This
will require partnerships and
new forms of communication
and data gathering with social
services, law enforcement and
other community resources
that typically have been more
peripheral to health care. The
most important participant,
however, will be an engaged
patient population that is better
educated and accountable for
their own well-being.
Health care systems have
started organizing their
community profiles into low-
risk, rising-risk and high-risk
categories. The majority of
our communities are low
risk, forming the base of a
population pyramid. However,
the lower numbers of high-
risk patients at the apex of
the pyramid represent the
majority of the cost in health
care. Health care systems are
deploying separate strategies
for the stratified populations
they serve – from a lighter-touch
wellness and system-branding
approach for low-risk patients to
a very hands-on, comprehensive,
longitudinal team approach to
care management for high-risk
patients. In order to win the
high-risk battle, they have to be
proactive and move upstream
into the low- and rising-
risk populations. This is the
metaphor that Dr. Jandel Allen-
Davis with Kaiser Permanente in
Colorado used in her TED talk,
“River of Health.”
The Advisory Board Company,
a DC-based consulting firm,
recently published an article,
“Food or meds? Find out
what your patients’ priorities
are?,” and reminded us about
Maslow’s hierarchy of needs
– the theory that the need
to survive trumps the need
for safety, security, health
and well-being. Patients who
are members of vulnerable
populations often are more
concerned with figuring out
where their next meal is coming
from than with taking their
medications.
In order to have an effective
care management program,
the social and environmental
barriers to health must be
addressed. Health care systems
have begun to use “big data”
to profile communities and
identify the hot spots where
their most costly health care
cases come from. With the
collection of this evidence,
health care providers are going
to the patients before the
patients come to them to find
them upstream before their lives
necessitate a visit to an acute
care facility.
A recent story on Colorado
Public Radio highlighted
findings that Colorado’s
most underserved health
care population is children,
particularly minority children
in low-income environments.
Through the collection of
demographic information,
Cincinnati Children’s Hospital
recognized that a certain
high risk part of town had 88
times more asthma-related
admissions than another
low-risk neighborhood and
the difference could not be
attributed to clinical or genetic
factors – they found a clear
correlation between asthma hot
spots and hot spots for housing
violations.
Denver Health and other
Colorado health care systems
have begun to use hot-spot
information to better target
upstream care locations for new
small neighborhood clinics or
assist school health programs in
those areas.
Dignity Health identified
five socioeconomic metrics as
proxies for health care access
at a ZIP code level. The metrics
include education, housing,
income, insurance status and
language. With this data, Dignity
Health developed a Community
Need Index score that can
assist efforts to craft a strategic
approach to neighborhood
needs and prioritize them.
We all need to learn how to
take better care of ourselves
and be more responsible as
individuals, but our health care
(and insurance) providers are
becoming more proactive about
influencing our lives.
Steve Carr, AIA
Principal, Health Practice lead,
H+L, Denver