The Celebration of Human Services’ breakout sessions are unique because during these sessions, expert panelists discuss issues of vital importance to the local health and human services community. This blog post recaps the session titled “Election 2018: Healthcare Coverage & Cost.” The panel was moderated by Dan Cohn, Vice President of Strategy, at Mt. Sinai Health Care Foundation.

The forum opened with comments from Patricia Shlonsky, Vice Chair of Community Solutions’ Board of Directors and Partner-In-Charge, at the law firm of Ulmer & Berne.

Cohn allowed each panelist to provide opening remarks. One panelist, Christin Farmer, cut right to the chase by saying that many of the policies that contribute to the dismal local health statistics, are rooted in racism and patriarchy. Farmer is the founder and CEO, of Birthing Beautiful Communities, an organization that focuses on community development to improve maternal and newborn health by identifying solutions to root causes of infant and maternal mortality.

“We educate the community, but it is not the community that needs to be educated, it’s the organizations that need to be educated.”

“We educate the community, but it is not the community that needs to be educated, it’s the organizations that need to be educated,” said Farmer. She said her organization has served more than 500 families, and while they’re currently concentrating on effectively serving Cuyahoga County, the goal is to eventually expand to Summit County. Farmer said that she is able to be on the frontlines, helping women achieve better health outcomes, but she is also comfortable in a room full of policymakers, who need to be informed about, and listen to, the needs of African-American women.

The United States spends more on health care than other developed countries around the world, but our outcomes are not good at all.

James Misak, M.D., Vice Chair of Community and Population Health for the MetroHealth system, opened with a disclaimer that his opinions are his own, and not reflective of the hospital system. That being said, he noted that the United States spends more on health care than other developed countries around the world, but our outcomes are not good at all. In other words, we are getting terrible value for our money. Much of that can be attributed to the fact that as a country, we underinvest in social determinants of health. So instead of dealing with issues “upstream” (meaning the root causes of health), we deal with health issues “downstream,” which are exacerbated by societal design. Misak used the example that if you live in terrible housing, then pills to alleviate pain caused by underlying factors affecting health (such as housing or transportation), are not going to help very much. He also stated how there are differences in how health care is administered now, compared to the recent past.

Social determinants are the conditions in which people live, work, play, study and pray.

“As health care providers, we are moving [from] a health system that was based on volume (we did the service, somebody paid), [to one] now based on value (the cost of the intervention is taking into account),” said Misak. When managed care and insurance providers now have “skin in the game,” this changes the approach, as they closely examine both services and costs. This means people can stay healthier longer, and also not break the bank. Social determinants are the conditions in which people live, work, play, study and pray. He said that research shows, when examining overall health in current society, your ZIP code matters more than your genetic code. Misak encouraged audience members to Google an article on Politico.com, “Health care’s ‘upstream’ conundrum.”

When managed care and insurance providers now have “skin in the game,” this changes the approach, as they closely examine both services and costs.

Amy M. Riegel, Director of Housing at CareSource in Dayton. CareSource is a healthcare provider, which currently serves five states. The provider is one of five companies that is certified by the State of Ohio to serve members of the population who are covered under Medicaid expansion – which in Cuyahoga County alone is 100,000 people. As a company, Riegel said CareSource frequently asks “how can we intervene with our members to give them the highest quality outcomes?” She went on to describe how 80 percent of outcomes are affected by where and how someone lives. For example, if mom just had a baby, and she is having complications, it is harder to go back to work. So every decision has both a quality of life and economic impact implication. CareSource tries to address social determinant issues like these, to better help moms “holistically”. As a result, CareSource helped 1,000 individuals get jobs, which will in the long term, bring about a higher quality of life.

Advocates have a responsibility to teach community members information they need to become their own advocates.

One of the social determinants that requires attention is housing. The next panelist, Megan C. Kelley, Esq., Vice President of Public Policy & Government Relations for National Church Residences addressed that topic. National Church Residences is based in Columbus and is one of the nation’s largest builders of senior housing. The company frequently learns about ways to create robust neighborhoods and support community-based services. Safe, decent, affordable housing inevitably affects the long term costs of health care, meaning if seniors spend money on housing, they will have fewer resources to use on other things that affect their health like transportation, health and food. They will stretch their prescriptions because they can’t afford medicine. She went on to state that one of the studies she read, described a need for more subsidized housing. Over the course of the study, Kelley said when housing was provided there was a reduction in Medicaid spending.

If seniors spend money on housing, they will have fewer resources to use on other things that affect their health like transportation, health and food.

The subsequent discussion focused on how organizations engage with the community. Farmer said that as advocates, we should talk about “equity” as a verb, not a noun. Communities have been historically and systemically denied resources, and because of that, African-Americans are 228 years behind in wealth and access to services that could help with societal issues. She said that across Cuyahoga County, there are only three black midwives. She later explained that the high cost of tuition creates an organizational barrier and thus a lack of access. Mizak said institutional policies such as disinvestment and redlining, affected communities of color. Maps today, which show communities that experience poor health outcomes, align with communities that were redlined.

There must be resources dedicated to healing and overcoming historical barriers, in order to build stronger communities and improve overall health in the long term.

During the audience question and answer, the panelists explained that more investments in housing, as well as protection of Medicaid expansion and advocacy for broader universal healthcare would go a long way towards addressing social determinants. That means that advocates have a responsibility to teach community members information they need to become their own advocates. Additionally, there should be examination of who holds organizations and institutions accountable.

Finally, the panel concluded that many of the factors that contribute to the high cost of health care and lack of coverage, is attributed to trauma, and there must be resources dedicated to healing and overcoming historical barriers, in order to build stronger communities and improve overall health in the long term.