The “frequent fliers” Our Homeless and Disadvantaged
Account for the running red ink in the hospital’s finances. Parkland needed to do something about them, and beginning in 2015 it did. That year, the Parkland Health and Hospital System christened a new $1.3 billion hospital, a 17-story glass-and-steel behemoth, shiny on the outside and quiet on the inside, funded by municipal bonds and donations from local oil zillionaires. It also launched an innovative new initiative that would reset the hospital’s ledger by creating a safety net for the city’s most vulnerable citizens.
Parkland Center for Clinical Innovation (or PCCI) was a joint effort with community partners such as homeless shelters and food pantries to build a network of what was hoped would eventually be hundreds of community-based social services around Dallas County, with Parkland Memorial at the center of it. A sophisticated software platform would enable the hospital to easily refer homeless people discharged from its emergency room to shelters and pantries, and to let social workers at those places see what their clients were doing: whether they were filling their prescriptions, or getting healthy food, or had a place to sleep, or money for the bus. It would be so much cheaper to meet those needs outside the medical system than to pay for the consequences inside it. Two years into the program, evidence is mounting that PCCI is working.
Senior Vice President Marilyn Callies cites the case of a man with hypertension and a stressful situation at home whose hospital bills dropped from $108,500 in December 2016 to zero by April as his health stabilized. Callies says on average hospital visits for some of the highest utilizers have been cut by two-thirds or more, saving an estimated $12 million.
I had a ‘Wow!’ moment when I saw these charts,” says Callies. Less than two years after its launch, the PCCI portal contains 150,000-plus names and had been accessed nearly a million times by 98 community groups, including some, like the local community college, that officials never anticipated would participate. And the list is growing. The Dallas public school system has expressed interest in using the portal to detect whether kids’ asthma medications are getting filled by their parents. There has even been talk of hooking up the network with the city jail, or the fire department because most of its calls are health care-related. The goal is to link 300 community groups by the end of 2018.
“We need to have one plan for the patient,” says Abraham. “When all community organizations and hospitals communicate, we can have one plan, and the entire community can link arms through this technology to quickly facilitate that need for this patient, and something that takes six months to do we can do in one month, and have a better outcome.”
People who study health care have known for more than 40 years that most of what makes people healthy or sick takes place beyond a doctor’s reach. Good sleep really does “knit up the raveled sleeve of care,” as Shakespeare put it, and it’s the stress of poor housing that aggravates a mental illness, the food desert that leads to a bad diet and diabetes complications, the cockroach-infested apartment that provokes asthma attacks, the feelings of low self-worth from an inadequate pay check that bring on depression and heart disease. Cumulatively, factors like these are known as the “social determinants of health.”
Sir Michael Marmot, the British epidemiologist who first used the term in the 1970s, has said the best way to improve health is to close the vast inequalities of money, power and resources. “Every sector is a health sector,” he wrote in 2014. “A toxic combination of unfair economic arrangements, poor social qualities and programs and bad governments, are responsible for these inequities in daily life which give rise to avoidable health differences. If we put fairness to the fore, it would reduce variable health inequalities. At the heart of this concern is one of social justice, but evidence really matters.”
Sometimes efforts by those who interact with the problems can find solutions in the most inopportune areas. Using your resources can oftentimes make a big difference in the lives of those you serve an your bottom line.
E. Bishop III, The Money Connection.Com
“Following The Money For Our Community”