What is a health enterprise zone?

FREEDMAN: It's a geographic area in which we look at all aspects of care that the residents might need — health, education, a sense of community, jobs, technology and more — to enhance their well-being. We need to increase job opportunities, provide new educational programs and, certainly, to coordinate health care across this enterprise zone. It's intended to focus not just on health, but also on private-public partnerships to invest in the community. By partnering with different organizations, it brings together different skill sets to help improve this impoverished area. In fact, the Philadelphia Chamber of Commerce is one of the groups that is working with us, and its focus and capabilities will actually help to promote investment in the area and add employment opportunities. If we can address poverty and upgrade income levels, we can produce housing, jobs and education.

Tell us more about the service area that inspired the enterprise zone partnership?

FREEDMAN: We consider North Philadelphia to be an eight-mile stretch between the center of the city to just beyond Einstein's location. In that zone, we [Hahnemann University Hospital, St. Christopher's Hospital for Children, North Philadelphia Health System, Temple University Health System and Einstein] treat about 300,000 Medicaid patients. This represents about 13 percent of all Medicaid recipients in the state of Pennsylvania. Slightly more than 30 percent of those live below the federal poverty line — twice the national average. So, we have a large number of extremely poor people in North Philadelphia. What is striking is that the life expectancy of children inside the health enterprise zone is 20 years shorter than for children outside the zone. In fact, the life expectancy of children in Syria and Iraq is longer. Obviously, this goes beyond just health disparities and health outcomes to the broader picture of poverty, homelessness, drug problems, poor education and inadequate housing. From a health care standpoint, we need to find better ways to reach the residents of North Philadelphia and resolve their unmet needs. We can start by coordinating and collaborating among our area health care facilities, which already are committed to making services available to those who are vulnerable.

What is your approach going forward?

FREEDMAN: Each and every one of our area emergency departments, on any given day, will see some patients over and over again for the same issues. Some come in once a month, others once a week and, frankly, some we see every other day. We have identified patients who use the ED 180 times a year. Patients may use more than one ED and, if they have behavioral issues or a drug dependency, they'll hop from place to place to try to obtain more medications and drugs. Each of our hospitals has different strengths, but we're going to focus initially on people who are heavy utilizers of emergency services because each of us has a significant number. We're going to start by gaining a better understanding of what needs are not being met, what gaps we have and how we can close those gaps by working together. With improved communication and coordination among our area hospitals, we can meet the needs of our patient population and at the same time reduce overutilization of our EDs, which represents millions upon millions of dollars' worth of care. Not only do we need to be sensitive to improving health outcomes of our patient population but, with limited and shrinking reimbursements and resources, we also have to be smarter in our approach. This partnership of health facilities and community organizations in North Philadelphia is a great first step.