Charting A Pathway To Better Health

• Published in: Health Affairs 2018-12, Vol.37 (12), p.1918-1922
• Main Author: Goldman, T. R.
• Format: Article
• Language: English
• Subjects: Access; Accountability; Adolescent mothers; Adults; Air traffic control; Airport towers; Birth weight; Clients; Clinical outcomes; Communities; Community; Community health care; Community health workers; Coordination; Employers; Employment; Females; Fingers; Halloween; Health care; Health care access; Health care expenditures; Health services; Health status; Healthy food; High risk; Homeless people; Homelessness; Housing; Internet; Low birth weight; Medicaid; Medical personnel; Medical workers; Medicine; Mental health; Negotiation; Neighborhoods; Nutrition; Parenting skills; Parents & parenting; Patients; Pediatricians; Philanthropy; Poverty; Pregnancy; Premature birth; Preventive medicine; Public health; Referrals; Risk factors; Shopping; Social factors; Workers
• ISSN: 0278-2715; 1544-5208
• DOI: 10.1377/hlthaff.2018.05166

On a bright Ohio morning a full month before Halloween, the orange holiday regalia was already out in force at the upscale open-air shopping mall in Perrysburg, ten miles south of Toledo. And in a booth at the local Bob Evans, Mark Redding was sketching a female stick figure to explain the social determinants of health. It's an intuitive and appealing concept-that such basic, nonmedical factors as employment, education, housing quality, and access to transportation, to name just a few, play a far greater role in health outcomes than direct medical care-and it is now widely viewed as self-evident. Far from obvious, however, is how to resolve, much less mitigate, the deleterious impacts of these often debilitating social determinants of health. Redding, fifty-eight, has long, fine grained fingers and the benign mien of a veteran pediatrician, and when he doesn't agree with you, he might push back by saying: "I would nudge you on that." But on the subject of the Pathways Community HUB, the care coordination model he developed with his wife, Sarah Redding, a fifty-seven-year-old physician who specializes in preventive medicine, his tone is messianic. It is, he says, "absolutely potentially transformative." The Reddings' model is rooted in the belief that a meticulous and coordinated attack on an individual's social determinants of health led by a trained, local community health worker can mitigate many negative social determinants and produce better health outcomes for people at high risk. In some cases, says Mark Redding, such an approach can help families break out of the multigenerational cycle of poverty in which they live. It's not that "care coordination" is a novel concept. Indeed, along with "social determinants," it is one of the buzziest phrases in health care today. However, the Pathways HUB model differs from other social determinants models on at least two important counts: First, it manages its clients with community health workers who come from the same neighborhoods as the people they serve. And second, the model's financial framework is premised on a monetary incentive that is realized by care coordination agencies-that is, the community health workers' employers-when HUB clients achieve measurable, positive outcomes in a host of factors, both large and small.Central to the Reddings' model is the targeting of "individual modifiable factors of risk," with risk being defined as a lack of something-be it housing, a medical home, food, employment,