How Can Health Systems Effectively Serve Minority Communities? Promote Health In Community Settings.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Monica E. Peek, MD, MPH, assistant professor of medicine and associate director of the Chicago Center for Diabetes Translation Research at the University of Chicago, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Peek is an alumnus of the Harold Amos Medical Faculty Development Program.
With the health policy introduced by the Affordable Care Act, health systems have a unique opportunity (and admittedly, a challenge as well) to transform themselves in ways that promote health and not just treat illness. Such efforts are particularly relevant for racial/ethnic minorities, which disproportionately suffer from the morbidity and mortality of chronic diseases that are largely preventable in nature. Lifestyle changes (e.g. dietary patterns, physical activity, tobacco cessation, and limited alcohol intake) can prevent or help manage the majority of chronic diseases in the United States, which are disproportionately present within minority communities.
To truly serve our minority patients and fully engage them in health promotion, health systems will need to do a better job of working with patients in community settings where they live, work, and play. Patients live in social communities of families, friends, and peers, whose support can prove invaluable to patients initiating or sustaining behavioral changes. Yet racial/ethnic minorities disproportionately live in communities that face barriers to health-related changes, including access to healthy food, safe places for physical activity, health education, and chronic disease self-management resources.
Fortunately, policy changes are making it easier for health systems to engage patients outside of the clinical setting and address some of the social and community-level barriers that can significantly impact health and health care costs. In January 2014, the Centers for Medicare & Medicaid Services (CMS) began providing Medicaid reimbursement for preventive health services by non-traditional health providers (e.g. community health workers), provided the services have been recommended by a physician or other licensed health professional. Other reimbursement changes (e.g. global payment systems, accountable care organizations) will support a greater emphasis on prevention, including behavioral changes that enhance disease control and reduce complications.
At the South Side Diabetes Project, our team has taken a comprehensive approach to engaging patients, within health systems and within the communities where they live. Moreover, we have sought to integrate the key components of our intervention, particularly the health system (i.e. quality improvement, provider training) and community components (e.g. community-based physical activity programs, grocery store tours), to provide seamless patient support for patients’ diabetes management. For example, physicians can write ‘prescriptions’ for healthy food (with an accompanying voucher or coupon) at a neighborhood Farmers’ Market or a participating Walgreens store. Once there, patients receive tours of the healthy food items available, participate in cooking demonstrations, and are exposed to other hands-on skills training to support healthy lifestyles.
Our program has been able to meet people where they are and provide the education, skills, and tools they need when they are ready for it, utilizing the infrastructure of the health system to support the process. We believe that there is a greater opportunity to promote sustained behavioral changes among patients when health systems changes are combined with community-based support programs.
In January 2014, the Affordable Care Act implementation began. Now is the time to strengthen relationships between patients, community organizations, and health systems to truly improve the health of our minority communities and other vulnerable populations.