Kaiser: Time for health systems to help mitigate social determinants

By Dennis Archambault

The Patient Protection and Affordable Care Act (ACA) underscored the importance of health systems to identify and meet the health needs of the areas immediately adjacent to their hospitals, not just the market segments they wish to serve. This is one of the unsung qualities of the much publicized law. In meeting this requirement, hospitals have been identifying these needs and developing action plans for addressing the needs, leveraging community resources. However, this work is largely done in isolation.

An analysis of Baltimore, one of the cities with the worst asthma rates, has concluded that hospitals need to invest on the front end of the problem, not profit from the patient care required at the back end. A report published by the Kaiser Health News and University of Maryland Capital News Service (https://khn.org/news/hospitals-find-asthma-hot-spots-more-profitable-to-neglect-than-fix/?) notes, “The medical system knows how to help. But there’s no money in it.”

The article references a resident of the zip code with the worst asthma rate, 21223, where an abundance of houses are in disrepair or abandoned, rodents and bugs trigger the disease, and few community doctors are working to prevent asthma emergencies. “Like hospitals across the country, (Baltimore hospitals) have done little to address the root causes of asthma. The perverse incentives of the health care payment system have long made it far more lucrative to treat severe, dangerous asthma attacks than to prevent them.”

Ben Carson, a retired pediatric neurosurgeon and Secretary of Housing and Urban Development concurs: “The cost of not taking care of people is probably greater than the cost of taking care of them… It depends on whether you take the short-term view or the long-term view.”

The ACA requirement is significant not only in getting hospitals to assume responsibility for the geographic area where they are situated, but also in preventing the conditions they treat, and profit from. It’s a significant adjustment for hospital marketing processes, which have for years targeted services and populations that are most profitable. Now, to retain their tax-exempt status, they must become allies in population health management. It may, in the end, contribute to the downsizing of the health care industry. On the other hand, as the euphemism goes, it may “right size” the industry.

Dennis Archambault is vice president, Public Affairs, for Authority Health.