What the home team knows

Nurturing the health of the people of a state is more like gardening then running a computer. Duh.

Nurturing the health of the people of a state is more like gardening then running a computer. Duh.

If you swing a bag of boiled peanuts near Raleigh these days you are likely to hit a lobbyist from an out-of-state managed care organization. If you have an American flag in your lapel, they will think you are a legislator and tell you why they should manage the $13 billion of Medicaid for poor people with their magical software . This is happening in every single state where Medicaid is in play, whether that state is considering expanding it or, as in NC, trying to figure out how to “fix it” so then they can expand it.

The legislators would rather spend some of those billions on roads, schools or something they can name after themselves. Only one of the 178 legislators has any experience in healthcare themselves and don’t entirely trust their own large healthcare providers much more than they do those from New York. (The best hospitals were founded with tobacco money, so there’s not a lot of moral high ground among us.) So they are receptive to the cost-saving promise. Why not let the financial geniuses from out of state run things?

Dr. John Hatch, Jeremy Moseley and Teresa Cutts talk about how to get 21st century science into people's lives.

Dr. John Hatch, Jeremy Moseley and Teresa Cutts talk about how to get 21st century science into people’s lives.

The only way to save money in healthcare is to manage the slow-developing conditions –usually linked to smoking, bad food, depression and anxiety—at the lowest cost point of care. And do that year after year. Every hospital and doctors office in America today is hoping that the criminally expensive electronics wwe’ve invested in will help. In practice this means digesting large amounts of data about patients to tell the doctor which patient needs what kind of early intervention or pill and what kind of test might be helpful to diagnose the next most important condition. Doctors know that kind of thing anyway without any machines at all.

What the doctor (and surely the computer) does not know is how to get their patient to get themselves within range of at least the drug store clinic in order for nifty 21st century medicine to work. Health care refers to this challenge as “patient activation”— the person needs to be active in their own life. Poor people live with everyone them telling them how to do everything better, so they are not excited about adding computers to their list of advisors, especially those owned by wealthy strangers trying to make money off their poverty.

Rev. Sam Hickerson is the pastor of New Light Missionary Baptist Church who grew up in the neighborhoods he now  serves as pastor and FaithHealth Liaison. His father was a bootlegger and he was a milkman before the ministry. He has worked for Baptist Hospital for more than 30 years. He knows a lot.

Rev. Sam Hickerson is the pastor of New Light Missionary Baptist Church who grew up in the neighborhoods he now serves as pastor and FaithHealth Liaison. His father was a bootlegger and he was a milkman before the ministry. He has worked for Baptist Hospital for more than 30 years. He knows a lot.

Activating patients one at a time is daunting when you are spending billions on millions. That’s why you have to activate neighborhoods—the streets, churches, small stores and soccer clubs where people live. Neighborhoods are the patient and like any patient, crucial to turn into a partner. All Southern streets may look alike to a northerner, but every one has its own pattern of health conditions (young Hispanics with work injuries; retired tobacco workers, cancer). And they have their own pattern of assets to activate. There is a lot to know.

To give you an idea of what is possible look to Winston-Salem where five kinds of doctors and two kinds of healers are weaving a fabric of less costly care:

  • Paul Laurienti is applying nero-science modeling to patient data, producing what look like brain maps that illuminate the expensive conditions emerging at neighborhood level.
  • Teresa Cutts of Public Health Science runs a complex participatory process producing a map of the assets in those same neighborhoods, including which are most trusted from those not.
  • Russ Howerton, the Chief Medical Officer activates a huge team of medical providers of every type and license to care for those sick enough to need a hospital (almost all of whom go back home quickly)
  • The doctors of the NC Community Cares Network manage all the outside the wall care now for Medicaid and while they are the constant whipped yard dog of the legislator, they have a rich array of field and clinical staff.
  • Marlon Hunter runs the County Public Health Department, wonderfully placed, but woefully underfunded working on the long slow problems through partnerships with school, apartments (while inspecting the food and preparing for the next epidemic).
  • Grace Terrell is the home-grown genius behind Cornerstone, a partnership of nearly 400 physicians who have distilled their complex knowledge into computer analytics that give our docs a highly tuned intelligence about their patients now being adapted by hospitals partners.

Canyons and committeesNone of this works without a ground game activated by two other kinds of knowing:

  • Annika Archie used to clean the rooms at the hospital, a low wage job with exquisite opportunity to learn what really matters to large numbers of patients. Last year, in a decision only a locally owned hospital could imagine, she was retrained and deployed into the toughest neighborhoods to follow the most vulnerable and poor patients home. As a Supporter of Health, she knows things computers don’t—including the fact that their silicon prescriptions are cruel without power or food in the house.
  • Sam Hickerson worked for the hospital for decades while also pastoring New Gospel Light Baptist Church right in the heart of the toughest streets in Winston-Salem. Now he is a FaithHealth Liaison using  what a pastor knows about the life of insults and deprivation, but also where to find honor and generosity.

Archie and Hickerson are the sharp edge of the lancet that can open the ancient wound and let the science in to do some good. You can calculate the community scale affect already in the pattern of charity care. As this new pattern in East Winston has emerged in the past two years charity care has decreased by 6% while going up in all the other zip codes in the surrounding counties. Laurienti would say this is positive story is as complex as a recovering brain. It is also simple: nearly $900,000 in reduced costs buys a very large bag of boiled peanuts.

About garygunderson

Vice President, Faith Health, Wake Forest Baptist Medical Center in Winston-Salem, NC. Author, Leading Causes of Life, Deeply Woven Roots, Boundary Leaders and Religion and the Heath of the Public. Secretary, Stakeholder Health (Health Systems Learning Group).
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2 Responses to What the home team knows

  1. Cindy_Ron says:

    Gary,

    Once I got past the reek of boiled peanuts this was a very interesting piece.

    What a challenge for those interested in health care outcomes and not some other measure of success – like profit. I don’t envy you the challenges of identifying and separating out the policies and expenditures that create real health. Not to mention, how to fund and encourage those whose job and commitment is to make a real difference in real patient’s lives. I remember we were in a workshop about providing food and assistance to those in need. A person who was an actual worker bee on the connection side of the issue called out a loud complaint to the moderator, who was showing one powerpoint statistical slide after another – “these are real people, not just numbers!”. Easy to forget when the big bucks start rolling across the conversation!?

    I am so proud of the work you do! Please keep on keeping on!

    love ya bro, Ron

    PS: Give me good MD unsalted, roasted peanuts in the shell – Please! > garygunderson > April 3, 2015 at 2:36 PM > garygunderson posted: ” If you swing a bag of boiled peanuts near > Raleigh these days you are likely to hit a lobbyist from an > out-of-state managed care organization. If you have an American flag > in your lapel, they will think you are a legislator and tell you why > they should” >

  2. Steven Scoggin says:

    A wonderful story to read this resurrection day! In fact, this logic can “roll the stones away.”

    Happy Easter Texas style.

    Steve

    Steven N. Scoggin, Psy.D, LPC President, CareNet, Inc. Assistant Professor in Psychiatry and Behavioral Medicine Director of Behavioral Health Reform and Transition Planning Wake Forest Baptist Medical Center

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