We’re only three days away from the 25th annual American Hospital Association Leadership Summit in San Diego. It's been a busy year for hospitals and this year’s theme is aptly called “Innovating in a Time of Change.”
Health equity is top of mind for the AHA, and many hospitals are taking the #123forEquity pledge to eliminate health care disparities and advance diversity and inclusion in health care.
As part of that, one of this year’s Summit keynote speakers is Rishi Manchanda, M.D., president of HealthBegins, an organization dedicated to achieving health equity. Manchanda will discuss a health care system that addresses the social health needs of populations using the upstream approach to care — improving population health outcomes, lowering the overall cost of care and improving the patient experience.
I spoke with Manchanda earlier this year for a story in H&HN, but because the Summit is only days away, we wanted to revisit the conversation to share additional remarks from that interview.
- Read all our coverage of the 2017 AHA Leadership Summit here
- AHA COO Maryjane Wurth highlights the speakers and sessions of the AHA Leadership Summit
- An earlier conversation with Rishi Manchanda
Below is a transcript of our interview, edited for clarity:
How would you describe the elements of the upstream approach to health care?
The first part of the approach is about making the case for social determinants themselves. The next step is to define how these issues impact health care. Sometimes health care providers will say, 'We understand that where people live and where they work plays a huge role in health, but our role is to take care of people when they're sick. We’re not community organizers, urban planners, workers or transportation specialists.'
Case in point: If you have a patient who routinely comes in and out of the emergency department, often the major driver of that is a nonmedical need. It tends to be linked to something like a lack of housing, food insecurity or social isolation. Those are nonmedical needs, but are vital to health outcomes.
The third element gets to the ‘how’ and speaks to the importance of taking the tools that hospitals already have, including quality improvement measures, to address the upstream drivers of poor health. What I call upstream quality improvement takes existing quality improvement tools and applies them to the root causes of major health care problems.
So, the four elements of a 'Get Ready, Get Set, Go Upstream' approach can help us to select and use upstream quality improvement methods, along with the tools, training and technical assistance, to improve the readiness and capability of hospitals to address upstream issues.
How do we begin to get those on the front lines thinking upstream?
There is no doubt that hospitals are at the heart of the culture of medicine. A lot of what happens in hospitals is what defines the culture of health care professionals' behavior outside of hospitals. I do think there’s incredible opportunity for hospitals to help model the types of thinking, training and tools to help those unmet needs when it comes to training or identifying the tools that don’t yet exist.
They can leverage their internal leadership development and training resources to include tools that address upstream issues, and do so with a clear objective. That’s not about making doctors into social workers, but making those inside the hospital, and community partners outside the hospital, work more effectively together. It’s about achieving what we all care about, which is better outcomes for our patients.
How important is upstream thinking in the move toward value?
I think it's fundamental. I can't underscore enough the vital transformative role that reforms and payments are playing in shifting our thinking about ways to move upstream. As we talk about the shift from volume to value, we don't often talk about who is driving. It's not just the federal government, it’s other payers or buyers out there. For instance, managed care organizations, particularly in the Medicaid managed care organization space. Medicaid managed care organizations take care of populations with a larger share of unmet social needs.
What role do other parties have in the shift toward upstream thinking?
The responsibility of health care is not to go at it alone when it comes to addressing social needs. The good news is that hospitals are not alone. There are so many organizations that are just as invested in improving outcomes for populations in certain communities.
The fact that so many different stakeholders, from payers to social service agencies and public departments, are thinking about improving outcomes and achieving better value means hospitals don’t have to do this alone.
What does the road ahead look like?
There's no doubt that there's a lot of uncertainty right now, but I think the opportunity for clarity that hospitals have is to not step away from what they are already doing, but to continue toward value. It's the responsible thing, but also because there is momentum. I think now we ask, 'How do we improve the effectiveness of our systems?' Part of the solution, I think, is this move upstream, to understand with rigor how to address these things.
For instance, tweaking quality improvement to address upstream issues is a way to be able to take an existing set of tools and achieve better value in this current environment. More and more, we have an opportunity to say one way to achieve better value is by staying upstream on issues for certain populations and addressing them in a concrete way.