When I envision the U.S. health care system, the first thing that comes to mind is a Jackson Pollock painting: splashes of color chaotically surrounding white space. The splashes of color represent existing health care venues and resources; the white space represents the gaps across our system that prevent patients from gaining the right access and the right support to improve their health.
Plenty of solutions have come to market in an effort to improve the delivery of health care. But most are aimed at filling the white space rather than organizing the chaos and better coordinating care delivery among the splashes of color. They are saying, “Hey, I’ll take this one area of white space — this one disease, this one organ, this one unfilled niche — and develop a solution to effectively address it.”
To be sure, some of these solutions deliver value. For patients, though, they often create increased fragmentation and a worse overall experience. For health plans, they create more complexity for care management. For providers, they further hamper their ability to have a complete picture of each patient and to successfully coordinate care.
Meanwhile, health care costs continue to escalate, despite all these point solutions promising significant cost reductions in their areas of impact.
I’m not suggesting there is no role for point solutions. The white space needs to be filled. Yet the U.S. must also solve the worsening fragmentation for people needing health care services.
New models delivering high-quality, coordinated care may be a solution. In this direction, federally qualified health centers can be a source of guiding light. A powerful example of this is Seattle-based Sea Mar Community Health Centers, an organization that has deployed a fairly simple equation to transform care delivery for its population. (This is not a self-interested promotion; I have no financial or other ties to Sea Mar.)
Sea Mar was founded in 1978 as a comprehensive health center for Seattle’s Latino community. It began with one small clinic in the South Park neighborhood. Today, Sea Mar is one of western Washington’s largest providers of community-based health and human services. There are four elements to Sea Mar’s winning equation.
Access is the mission. With a vast network of brick and mortar locations, coupled with community health workers and other methods for delivering in-home care, Sea Mar increases basic access to care for all its patients.
Trust is the standard. The organization aims to create trust among its members by personalizing support based on their needs. In the early days, Sea Mar’s population predominately spoke Spanish. Today, its members speak 50 different languages. Sea Mar solves for this with care coordinators and interpreters to bridge language and culture gaps. Every step of the way, Sea Mar builds equity with members by consistently responding to health care needs and doing so in a way that incorporates and accounts for their specific cultural and social needs.
“You can’t be effective without trust,” Julian Perez, the physician leader for Sea Mar, told me. “We come from the community. We identify and relate with our patients, which is a big part of it.”
Primary care is the engine. To simplify navigating the system and increasing coordination of care, Sea Mar brings as much as possible under the purview of primary care. It sees primary care as the quarterback for each individual’s health care journey.
Value-based reimbursement pays the bills. The final piece of the Sea Mar formula is financing. The organization leans heavily on value-based models for reimbursement. Such models provide it with the flexibility needed to deliver care differently and to do what’s best for each patient while remaining financially stable. Value-based models allow the plan to invest in areas of need and to direct resources to patients who are at highest risk.
Sea Mar has created continuity among physicians, hospitals, and specialty care to manage best practices, improve transitions of care, and build in additional layers of support for its members. This includes making sure patients have multiple ways to communicate with the plan based on their preferences. They also try to address social barriers and determinants directly, with health education delivered through their own radio station, and connections that provide transportation and healthy food.
Learning from the Sea Mar model
Sea Mar offers several lessons for health systems and medical practices. First, it’s important to gain a better understanding of which primary care medical groups are performing at a high level within a given network. Partnering with these groups to improve their ability to generate even better outcomes is a great path forward. And then, it’s about leading members to those provider groups, particularly those members who are more vulnerable and medically complex.
Second, providers must find ways to prevent patients with complex medical, behavioral and social needs from falling through the cracks. This is easier said than done, especially for providers who are grappling with capacity challenges, staffing shortages and burnout on a regular basis. However, partnering with other available local and regional community care providers to deliver in-home services extends care access to those who need it.
Finally, providers must invest in the right services and solutions to meet their unique patient care needs and organizational goals. This includes data analytics capabilities, care processes and development of a multi-disciplinary team — such as pharmacists, social workers and community health advocates — who can expertly extend the reach of health system and medical practice providers. To do this correctly also requires partnership across multiple stakeholders, including regional health plans, public health departments and care organizations that can also act as an extension of clinical teams.
Together, we can both fill the white space and better connect the ecosystem so that we more effectively and holistically support patients — particularly those who are vulnerable and underserved.
Chris Dodd is an internal medicine physician, clinical instructor at the University of Washington School of Public Health, and chief medical officer at Emcara Health. He also serves on the board of the Home Centered Care Institute.