As the healthcare landscape changes, medical charities are adapting their approaches to meet clients’ needs more effectively.
The ACA has dramatically affected the role of charitable care groups in the United States. Although many such organizations still offer direct care, analysts detect a shift in recent years toward proactively addressing social determinants of health as well.
That new focus reflects a growing understanding of sociocultural and other influences on health. For example, in breaking down causes of premature death, a study in The New England Journal of Medicine found that 20 percent of contributing factors are social or environmental. Charitable care organizations are increasingly making it part of their mission to address those factors — a transition that has picked up steam since the implementation of the ACA.
The Evolution of an Organization
“We saw community-based charity care programs moving into the enrollment space in direct reaction to the ACA and the coverage expansions we saw via Medicaid and the Marketplace,” says Maia Crawford, MS, Senior Program Officer at the Center for Health Care Strategies (CHCS), a New Jersey-based organization that works with states to promote innovation in publicly financed healthcare services. “[They became] enrollment assisters, as navigators or other types of enrollment assistance providers, and helped connect beneficiaries they work with on a daily basis to coverage if those individuals are eligible.”
Crawford’s organization has written extensively about this change, and a recent paper by CHCS notes examples.
Ingham Health Plan Corporation, a community health plan based in Lansing, Michigan, is among the organizations that have revamped their roles in light of the ACA.
Robin Reynolds, MTA, Executive Director of Ingham Health Plan, saw a dramatic shift in the population served by her organization after the ACA took effect. Whereas Ingham Health Plan had served as many as 15,000 individuals, it now serves approximately 1,200 due to many of its members becoming eligible for coverage under the ACA and Medicaid expansion. Most remaining clients are noncitizens, Reynolds adds.
“We still run a small plan for people who are uninsured,” she says. “With a smaller population, we’ve also been able to expand the benefit a little bit. It’s basic coverage — we basically cover everything but inpatient and emergency department.”
“We’ve seen this continuum, in recent years, move toward addressing a more complete picture of patients’ health, taking on that more holistic viewpoint.”
- Maia Crawford, MS, Senior Program Officer, Center for Health Care Strategies
Addressing Social Determinants of Health
However, up to 60 percent of a person’s health and well-being result from individual behaviors and social and environmental factors, compared with only 10 percent directly related to health care, according to a 2015 report by The Kaiser Commission on Medicaid and the Uninsured. For many, social disadvantages, often systemic, are barriers to achieving health equity, and observers say that necessitates a bigger-picture approach. Some medical charities feel they can be more effective by zeroing in on those issues in addition to directly connecting patients to treatment.
Besides taking on the role of navigator and guiding eligible individuals enrolled in the Ingham Health Plan to medical insurance, the organization has developed a Pathways Community HUB, a resource that connects a seven-county region in Michigan. The HUB works as a single point of contact for multiple providers serving one client through community health workers (CHWs). CHWs team with patients to address not only medical needs but social determinants as well.
“Housing is one — permanent, stable housing, which is difficult to come by,” Reynolds says, adding that behavioral health is also a particularly important, if often unrecognized, social determinant of health.
Other factors that are more often being addressed by charitable care organizations are nutrition and exercise. Assistance to clients in these areas frequently comes in the form of memberships to local gyms or YMCAs, cooking courses, or even basic nutrition information classes, according to Crawford’s research. Classes may be offered through a charitable group itself or through a community resource the patient is connected with by one of the organization’s navigators. Programs also connect clients to services such as food banks and shelters when necessary.
“What we’ve seen as most prevalent in these early stages are referrals to partner organizations or to other community-based organizations that meet some of those non-health needs,” Crawford says. “In some cases, this is a somewhat formalized relationship in which there are these direct referral links, or certain individuals who kind of wear multiple hats who are able to address those health needs and non-health needs. In other cases, it’s something like a program having a list of available resources in their community and providing that information to their member. ... [These are needs] that again are maybe not directly health-related but that we know in the longer term impact overall health status.”