Community Development and New Understandings of Health and Wellness

Posted by Jeremy Liu on August 13, 2012

In June 2012, I attended the Institute for the Future’s Health Horizons conference Innovating Information Ecosystems: The Next Decade and Beyond as an expert on the importance of place in the ecosystems of well-being. It was an exciting and timely event to be part of as I've been engaged in other conversations and projects that apply community development as the praxis of social epidemiology and the social determinants of health.

The Institute for the Future describes the need to imagine what lies on—and beyond—the horizon for health because “New understandings of health and well-being highlight the importance of imagining health interventions that do not simply act on our individual bodies, but operate at multiple scales.”

Exactly. This is as succinct a statement for the emerging leadership role for community development corporations as health actors as I’ve heard. I read this statement as a call to community development corporations to recognize their role as actors in the health and well-being of families and neighborhoods and communities—a call I gladly echo. We have too much to offer to the vision of healthy and vibrant neighborhoods for all communities. When it comes to health, we can't relinquish the responsibility that comes with our capabilities and our missions.

From the two days of forecasting and unleashing our imaginations among industry and academic researchers and health practitioners, the insight that stands out to me the most I gleaned from the news that the almost ubiquitous national, for-profit dialysis chain DaVita Inc.—one of the country’s largest providers of end-stage renal dialysis—was purchasing HealthCare Partners, the country’s largest operator of medical groups and physicians networks. This is an obvious move to position DaVita to evolve into a leading Accountable Care Organization, a major component of health care reform that survived the recent Supreme Court decision.

The end could be just the the beginning.

From the joint statement the two companies released on May 21, 2012:

"We look forward to working with DaVita to extend our patient-focused and physician-led integrated care model to serve the needs of patients, physicians, and payers in new markets and in new ways.  DaVita’s vision ‘to build the greatest healthcare community the world has ever seen’ and HealthCare Partners’ aspiration to lead the transformation of American healthcare to higher quality, efficiency, and value are absolutely complementary to each other."

What I appreciate the most about this move is that a “downstream” care entity like DaVita leveraged their strengths in patient-facing services and integrated care for just chronic kidney disease, not dissimilar to the focused strengths that community development corporations bring to family-facing services and programmatic integration around housing.

In the same statement, Kent Thiry, Chairman and CEO of DaVita, stated:

“We believe our combined enterprise will offer new and exciting levels of clinical quality, service, and consumer/taxpayer savings.  DaVita currently executes on its integrated care mission with thousands of physician partners across the country for specialized kidney care services.  HealthCare Partners executes on that same mission across a full and deep array of healthcare services in three geographic markets. This combination will create a unique patient- and physician-focused organization.”

Wikipedia describes an Accountable Care Organization (ACO) as: "a healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers form an ACO, which then provides care to a group of patients."

Community development corporations have long been responsible for the “housing determinants of health” such as providing mold- and pest-free living conditions, a well-understood and often doctor-prescribed “treatment” for asthma.  With each passing day, social epidemiology researchers are uncovering significant correlations between other social conditions and health outcomes, these are known as the social determinants of health.

[Ed. note: See "The Interesection of Health Philanthropy and Housing" by Marjorie Paloma, senior policy adviser and senior program officer at the Robert Wood Johnson Foundation, in the spring 2012 issue of Shelterforce.]

Evidence is mounting from social epidemiology that points to the overwhelming influence of place—where families live, learn, work and play—on health outcomes.  Peer-reviewed, published studies have found that while health care access and other genetic factors are important determinants of health, total health outcomes are more dependent on place and place-based social factors.

Is it too far-fetched to imagine a community development corporation becoming a party to an emergent Accountable Care Organization model that situates the improvement of place as the ultimate preventive health practice? The Affordable Care Act includes a new program called the Medicare Shared Savings Program Accountable Care Organization designed to bring together networks of doctors, hospitals, and other health care providers to achieve "better population health management, lower per-capita cost and an excellent patient experience."

In as early as 2008 in Springfield, Mass., a community health care center working with the MIT Community Innovators Lab mounted a comprehensive, block-by-block and house-by-house survey that resulted in a health profile of the entire community. With the range of significant health issues facing the community mapped out on a GIS system they then developed individualized health maintenance plans for all residents.  With this they made a deal with Medicare and Medicaid that they would split every dollar saved. In the first year they saved $2 million and they took home $1 million.

Why not form a group health insurance plan based on place rather than employer?  Why couldn’t a health insurance company and a community development corporation form a visionary and progressive partnership to be accountable for the health and life outcomes of the community development corporation’s residents, sharing costs of prevention and savings from wellness?  Some insurance companies already invest in the low-income housing tax credits that community development corporations use to finance their affordable housing developments.

To take a partnership further, the insurance company would take on all the residents as health insurance clients in partnership with the community development corporation to deliver coordinated and integrated preventative services framed by the social determinants of health.  This partnership aligns the capabilities of the community development corporation (whole family, neighborhood quality of life, and life course services and support which are greater determinants of positive health than health care access) with the financial and health management resources of the insurance company.

If we open our eyes, the writing is on the wall for the community development corporations, it just happens to be on the walls of health care reform.

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See the spring 2012 issue of Shelterforce, "Are our neigborhoods making us sick?"

About the author more »

Jeremy Liu is an artist and community development consultant. He is a principal of Creative Ecology Partners (www.creativeecology.net), and senior fellow with PolicyLink (www.policylink.org). He has served as executive director of the East Bay Asian Local Development Corporation in Oakland and the Asian Community Development Corporation in Boston.

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