Culture of Health Blog

New research shows that seniors who participate in the SNAP program are much less likely to be admitted to nursing homes and hospitals, demonstrating the power of investing in social services to reduce health care costs and improve health outcomes.

Large-scale collection of patient data into disease-specific databases, or registries, is vital to research. These registries house standardized information on patients’ diagnoses, care, and outcomes, supporting large-scale comparison and analysis which can lead to better population health management and interventions. But can disease registries also help to move us closer to patient-centered care?

We’re learning from examples overseas that, with the help of new interactive technologies, they can.

Sweden created a disease registry for rheumatology that is much more than a data storage house. The Swedish Rheumatology Quality Registry (SRQ) is an interactive tool that helps patients and doctors prepare for and make better use of their office visits. It helps them to work like a team—to “co-produce” care together.

In a blog post for The New York Times, Dr. Dhruv Khullar, a resident physician at Massachusetts General Hospital, detailed important—and importantly nonmedical—barriers to health that he had witnessed in his patients: a man who couldn’t fathom worrying about his blood pressure when he needed to find food and a place to sleep, a diabetic without reliable access to a refrigerator to store insulin, a mother fretting that mold and cockroaches in her apartment were exacerbating her son’s asthma. Medical care might be necessary for these patients. But that care alone is unlikely to be sufficient.

We’re all well aware that education leads to better jobs and higher income. Just as important, research also links education to reduced risk of illness, increased vitality, longevity and academic success that extends to future generations.

That’s why the situation for schools in Lawrence, Mass., was particularly concerning back in 2010. At the time, more than one out of every four Lawrence kids dropped out of high school. This led the Massachusetts Department of Education to put Lawrence’s schools into receivership by 2012, placing them under new management to safeguard state assets. The state-appointed “receiver,” was granted authority to develop an intervention plan to overhaul the schools through steps you might expect such as expanding the school day and replacing half the districts’ principals.

But the district also took one critical step by acknowledging that a family’s financial stability strongly influences how well children do in school—and whether they drop out.

What does it take for Americans to lead healthier lives? Seems like a simple question, but it takes research to get answers we can act on.

Research is how we will discover what happens to resident and community health when a low-income community in Seattle—pocked with aging infrastructure and troubled, publicly subsidized housing—is transformed into one that sports mixed-income housing, new parks and services that support well-being. It’s a way we can measure the value of litigation aimed at forcing school districts in California to comply with state requirements for physical education in schools. Through research, we can pinpoint whether the presence of children in a defendant’s life influences sentencing decisions. And only through research can we further understand how criminal sentences impact the overall health and living arrangements of these children.

The Robert Wood Johnson Foundation (RWJF) is funding these and other studies through its Evidence for Action (E4A) National Program, now in its second year. We want to continue making grants through E4A, which is why we invite you to explore our Call for Proposals (CFP).

Health care is too often the most stressful part of the American family's budget. In a 2015 survey from the Kaiser Family Foundation, 42 percent of respondents reported that it is somewhat or very difficult to afford health services. This difficulty ranked higher than monthly utilities, housing, food expenses and transportation costs. In the same survey, more than half of respondents said that making information about the price of medical appointments, procedures and tests more available to patients should be a “top health care priority” for the President and Congress.

Rising out-of-pocket costs helped shape these attitudes, and they are hitting patients in the U.S. at all levels. For people with job-based insurance, the number of individuals with plan deductibles—and the size of those deductibles—has grown rapidly in recent years. In 2015, the rate of covered workers enrolled in a plan with an annual deductible of $1,000 or more for single coverage was 63 percent, a significant jump from 10 percent in 2006. This year, deductibles in marketplace plans are even higher than employer insurance, averaging $3,064 for coverage in the popular "silver" tier. For low-income marketplace enrollees, they might qualify for cost-sharing reductions, but they aren’t completely shielded from out-of-pocket expenses.

How can we lower the burden of health care costs in the U.S.?

At RWJF, we’re focused on solving the most intractable health and health care challenges in the United States, but we recognize that innovations come from all over the world and that many effective health solutions are emerging with the potential for immediate adaptation, replication and impact. That’s largely because, despite their differences, many countries throughout the world face a surprisingly similar set of health care challenges.

In today’s interconnected world, we have an important opportunity to learn from each other – especially when a new idea has the potential to make a difference in a big way. For example, the New York Times recently released a special section, “Small Fixes,” which focused on low-cost health care innovations to improve global health. The small fixes ranged from simple, self-adjusting eyeglasses for those who don’t have access to optometrists to the sophisticated, Gates-funded “postage stamp” paper to detect liver disease nearly instantaneously—the samples don’t have to be sent to a laboratory to be processed.

The innovation that most caught my interest in this article was one in Mozambique that organized patient groups to take turns picking up their medications, thereby forming strong social bonds, reducing stigma and increasing adherence to antiretroviral drugs. The organized patient groups also reduced the burden on health care workers while increasing patient engagement and self-management of care. Some consider this “small fix” a potential game changer for HIV care.

What’s striking about many of these solutions is that they highlight the universality of health problems faced throughout the world, such as lack of preventive care, provider shortages and rising health care costs. And, while most of the solutions are geared towards solving health problems outside of the United States, with some imagination, I believe many of these fixes could easily improve people’s lives in our country.

It’s this desire to accelerate change by tapping into unconventional thinking around the globe that led the Pioneer team to partner to launch the Innovations for Health: Solutions that Cross Borders competition with Ashoka Changemakers. We’re looking to find solutions to these universal health care issues, and are most interested in those that have potential to:

• Increase capacity and training for health care workers and providers;
• Scale low-cost interventions to increase access to medical, preventive, or dental care;
• Reduce barriers to health information and services;
• Provide high-quality care in non-traditional settings; and
• Engage patients directly in their care, particularly those managing chronic illnesses.

We’re thrilled to seek these global health care solutions and hope you’ll check out the competition, learn more about the three $10,000 prizes, and share the link with your network of pioneering thinkers. And why not submit an entry yourself, nominate an organization to compete, or comment on the submissions? We can’t wait to see what ideas you might have.

This commentary originally appeared on the RWJF Pioneering Ideas blog.