Health Reform That No Judicial Ruling Can Stop

Health Leads CEO Rebecca Onie says health reform, particularly for the poor, will continue despite the current uncertainty
Health Leads CEO Rebecca Onie says health reform, particularly for the poor, will continue despite the current uncertainty

In the wake of yesterday's decision in the federal district court in Virginia that a key provision of the health care law is unconstitutional, as well as a November's midterm elections, the fate of the Patient Protection and Affordable Care Act is increasingly uncertain. Just as major pieces of the bill have started to fall into place, debate and division over the legislation’s implications have only intensified.

As CEO of Health Leads, I spend much of my time speaking with physicians, hospital administrators, third-party payers, and health systems CEOs, representing a variety of health care delivery models. In these discussions, one theme emerges time and again: regardless of the ultimate disposition of the health care reform legislation, certain forces have been set in motion that create an unprecedented window to redefine what the U.S. health care system pays for, and thus the scope of care provided.

Paying For Prevention

In particular, two trends create a potentially once-in-a-generation opportunity to reshape health care delivery – and to do so in ways that are better aligned with the needs of low-income patients. First, the evolution – whether rapid or incremental – from fee-for-service payments toward accountable care organizations, global payments, or other forms of partial or full capitation makes the failure to pay for prevention increasingly untenable.
Providers 'Practicing At The Top Of Their License'

Second, consistent with concerns regarding health care spending and workforce shortages, there is a growing expectation that all health care providers will “practice at the top of their license,” i.e., focus on those activities that best leverage their training and experience.

This upstream migration of health care professionals creates an important market opportunity to engage lay workforces historically marginalized in the U.S. health care system.

The current shortage of physicians and nurses, especially in primary care settings, will become even more urgent as millions of new health care consumers enter the market, including many previously uninsured. For health care institutions serving low-income patients, this problem is magnified further: for these patients, the challenge is not just access to or quality of care but their unmet resource needs that impact health and inevitably surface in the exam room.

Indeed, every day in America, doctors prescribe antibiotics to patients who have no food at home or are living in a car. Of course, medicine alone won’t solve these problems, and many of the patients will return with more serious — and more expensive – illnesses. But, for the most part, doctors don’t have the time or knowledge to address patients’ basic resource needs, particularly as patient volume escalates.

Shortage of Social Workers and Case Managers

At the heart of this challenge is the severe shortage of clinic-based social workers and case managers. In a typical scenario, the Washington Heights Family Health Center in New York has one social worker for its 47,000 mostly Spanish-speaking patients. Consequently, those few clinic-based social workers must necessarily focus on child abuse, mental health, and complex diagnoses. There is no capacity left for preventing potential crises, such as the family squeezed in a one-bedroom unit with three other families.

Solution: Clinic-Based College Volunteers

Health Leads offers one solution. In the clinics where we operate, doctors can “prescribe” food, housing, or other critical resources, just as they would medication. Patients take their prescriptions to the clinic waiting room, where Health Leads’ corps of well-trained college volunteers are ready to connect them to these resources. Last year, Health Leads mobilized 660 college volunteers to assist nearly 6,000 low- income patients and their families in accessing the resources they need to be healthy. Health Leads operates in 22 pediatric and prenatal clinics, newborn nurseries, emergency rooms, and community health centers in six cities.

Health Leads’ scalable, affordable, clinic-based model empowers physicians and other health care providers to ask the previously “unaskable” questions: Are you running out of food at the end of month? Do you have safe housing for your family? At the same time, Health Leads complements the care provided by doctors and social workers, leveraging their more scarce time and allowing them to focus exclusively on those activities that demand their training and experience.

This program aired on December 14, 2010. The audio for this program is not available.

Headshot of Rachel Zimmerman

Rachel Zimmerman Reporter
Rachel Zimmerman previously reported on health and the intersection of health and business for WBUR. She is working on a memoir about rebuilding her family after her husband’s suicide. 



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