Tag Archives: Patients

Three Strategies for Improving Social Determinants of Health

A shoutout to Irving Stackpole for bringing this to our attention today on LinkedIn. This is an important topic that can address the serious issue of poverty in our inner cities.

The topic of food deserts first gained national attention thanks to the efforts of former First Lady, Michelle Obama, who not only created a vegetable garden on the White House grounds, but championed the creation of other gardens in inner city elementary schools.

One in particular was created at a Washington, DC school, and Mrs. Obama invited Chef Robert Irvine of Restaurant: Impossible to cook for inner city school children at Horton’s Kids, a local community center that provides after-school meals for kids.

So an article last week in Managed Care magazine, discussed the three strategies health care systems and payer organizations are trying to address patients’ social needs.

The first strategy, Tackle a neighborhood, focuses on the work ProMedica, a 13-hospital not-for-profit system in Toledo, Ohio is undertaking.

In the UpTown neighborhood of Toledo, the average median household income is less than $21,000 a year, and more than a quarter of all adults have not completed high school. Few residents have homes or vehicles, and healthy food options are hard to come by.

One way they are dealing with the food deficit in the neighborhood is by opening a grocery store called Market on the Green, and is a joint project of ProMedica and the Ebeid Institute.

They also initiated a job-training program, a financial opportunity center, and personal-finance advice and programs.

Last year, ProMedica doubled down and announced a 10-year plan to invest $50 million to create a national model for neighborhood revitalization. In March, they announced a partnership with a New York City-based nonprofit to invest additional capital to spur further economic growth.

Lastly, they expanded their screened 4,000 Medicaid patients who use the food clinic, and found that emergency department utilization decreased by 3%, and 30-day readmission by 53%, with a modest increase in utilization of primary care.

They also expanded screening  to include housing, transportation, and other social needs.

The second strategy is Tackle the top problems.

Here, Humana has been working on its Bold Goal, a population health strategy to improve the health of the communities it serves by 20%.

Humana wants to increase the number of “healthy days” in seven markets: Louisville, KY; Knoxville, TN; San Antonio, TX; Broward County, Fl; Baton Rouge, La; New Orleans; and Tampa Bay.

In the first year, the San Antonio market showed a 9% increase in healthy days, which was attributed to several initiatives, namely a telepsychiatry pilot to increase access to behavioral health services, food insecurity screening at primary are offices, and a collaboration with other organizations to improve diabetes management,

Finally, the third strategy is Develop a social determinants workforce.

Trinity Heatlh, a 93-hospital health care system in Michigan, and one of the largest Catholic systems in the country, has been addressing their patients’ social needs through a series of small experiments.

Trinity’s strategy is to develop a cadre of community health workers who will use pathways, regimented, evidence-based multistep protocols to help individuals address their specific needs.

Trinity found that by focusing on patients covered by Medicare, Medicaid, or both, and assisted by community health workers, they reduced their emergency department and hospital utilization considerably.

Trinity also hired AmeriCorps workers to serve as community health workers in nine markets. They focused on the social determinants of health of a narrow group of patients: high-utilizing eligibles in an ACO or other at-risk contract.

The strategies these organizations are undertaking are bold initiatives that show some promise of success, but time will tell just how successful they will be.

Yet, in an era of huge tax cuts going to the wealthy, and budget cuts  eliminating many government programs or severely limiting them, these companies are taking decisive action to reverse decades of neglect and despair in our inner cities.

But they won’t be effective unless there is greater cooperation from the communities they wish to serve, and from the rest of the health care community, and those in other institutions.

There is an accompanying story here: Social Determinants of Health: Stretching Health Care’s Job Description.

The IMTCC Is What Medical Tourism Is Supposed To Be

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I’d like to take this opportunity to introduce you to another one of my LinkedIn connections, who is part of the medical tourism industry. Her name is Christina de Moraes, and she is the CEO and founder of the International Medical Tourism Chamber of Commerce (IMTCC), located in California. Christina has been involved with medical tourism, as both a patient and a patient advocate for more than ten years when she first began her “Medical Concierge” services in Brazil.

She was the President and founder of MedNetBrazil and MedNetCostaRica from 2002 to 2012, and she has been a consultant for the Medical Tourism Industry, as well as a Patient Advocate and Plastic Surgery Consultant for the very specific techniques of Post Massive Weight Loss Reconstruction and Brazilian Plastic Surgery techniques, as well as bariatric surgeries.

Christina has spent 10 years as a cultural, medical, social and business liaison between her patients, her company and Brazilian medical providers, marrying the needs of each to achieve mutual benefit, create trust, improve results and implant ethics in medical tourism facilitating.

She founded the IMTCC in May 2012. Her reason in founding the IMTCC was so that medical tourism consumers/patients, health care providers, and medical tourism service providers could have an unbiased source to guide them on matters of competence and trust.

There are three tenets of medical tourism that members and providers are committed to providing so that patients will have a safe and successful medical tourism experience. The three tenets are:


The IMTCC’s Mission Statement expounds on the three tenets and lays out the mission of the IMTCC as a reliable and trustworthy organization committed to the highest standards.

IMTCC Mission Statement

To Formally Declare, Endorse and Implement the Three Tenets of Medical Tourism:

ADVOCACY, AFTERCARE and ACCOUNTABILITY … Paving the Way to Accreditation Standards

Provide a Leadership Role in Advancing Marketplace TRUST and Industry INTEGRITY

Set Best Standards of Practice and Patient Centered Care Delivery, Regardless of International Borders.

Epitomize Result and Performance-Based Membership Standards and Transparent Reporting Practices

Promote the Use of Best Standards of Practice by Offering Coordinated Workflow Protocols and Homogeneous Patient Care Processes

MACSS – Medical Aftercare and Concierge Support Services

Provide Training, Mentoring and Constructive Feedback to Chamber Members as a way to add integrity and value to the Services and Expertise They Offer to Patients.

Create an International Network of Accomplished Medical Tourism Services Providers and Preeminent Healthcare Professionals

Provide Education and Unbiased Advice to Patient Consumers and the Marketplace

Represent the VOC – Voice of the Customer – to Healthcare, Insurance and Medical Tourism Providers

Denounce Substandard Industry Performance, Behaviors and Practices Through Unbiased and Diligent Compilation and Transparent Disclosure of Important Industry Outcomes, Complication Rates and Patient Satisfaction

Celebrate Both Healthcare and Industry Role Models, Visionaries, Motivators and Innovators

Become Internationally Recognized as the Trustworthy Resource to Turn to for Objective, Unbiased Information on Medical Tourism and International Healthcare Providers.

Promote the Three Tenets as a Global Model and Catalyst for Change in the Delivery of Healthcare

As the medical tourism industry is still a relatively new and growing industry, there are problems, as there is with any other new industry, and it is up to the members of that industry to figure out how is the best way to promote and market its services to the public, as well as to provide the public with assurance that their industry is open, honest, above-board, and adheres to the standards and ethics of any other business.

Medical tourism certainly has its pluses and minuses, and there are organizations (won’t name them here) that have not lived up to the expectations of the members of the medical tourism industry, and it is the duty of organizations like the IMTCC, and a new group that Christina told me about recently, called the Global Healthcare Travel Council, to correct the mistakes others have committed. The IMTCC is one of those organizations, and I thought it was vital that the workers’ compensation industry got to know them a little.

The end of the ‘Doctor-Patient’ Relationship?


While perusing my local South Florida newspaper, I happened to find an opinion piece written by Sally Pipes, the President, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute. Ms. Pipes’ article, “Obamacare may put end to doctor-patient relationship” states that the Affordable Care Act, i.e., “Obamacare” is putting an end to the traditional doctor-patient relationship, which she believes will lead to “assembly-line medicine” and impact the quality of patient care.

Some of her criticisms have been addressed in earlier blog posts, especially “Is Medical Tourism “Anti-Union?” where I mentioned that doctors are becoming salaried workers and may one day form a union and gain collective bargaining rights.

But what really caught my eye were the following comments she made:

Fortunately, Americans determined to receive personalized care aren’t without options. In addition to concierge practices, another tactic growing in popularity is medical tourism — traveling abroad for treatments and procedures, often at more affordable prices. This year, three-quarters of a million Americans will travel outside the country for non-urgent care.

The medical tourism group Patients Beyond Borders estimates that Americans can save 25 to 40 percent on their medical bills by traveling to Brazil. For Costa Rica, it’s 45 to 60 percent. And in Thailand, the savings can reach 70 percent.

So if she is right, and the ACA brings an end to the traditional doctor-patient relationship, wouldn’t that also affect the way injured workers receive care? So if Ms. Pipes is advocating patient choice in medical tourism for individuals seeking better medical care, shouldn’t that apply to workers’ compensation? Or are workers “undeserving” of such care?