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2017 Health Leads Inc.
Working Collaboratively to Address
Jennifer Valenzuela, LICSW, MPH, Principal of Program, Health Leads
Michelle Zambrano, Program Manager, Health Leads NY
28th Annual Conference of the Network for Social Work Management
June 15, 2017
Fordham University Graduate School of Social Service
New York, NY
2017 Health Leads Inc. 2
1 in 5 Americans receives healthcare via Medicaid, including 45M children
Many present with significant unmet basic resource needs food, heat, electricity, housing, education
Data shows these patients disproportionately struggle with obesity, asthma, high blood pressure, depression, and diabetes
Mismatch Between Drivers of Health & Spending
2017 Health Leads Inc. 3
Source: Healthy People/Healthy Economy: An Initiative to Make Massachusetts the National Leader in Health and Wellness. 2015.Data from NEHI 2013. http://www.tbf.org/tbf/56/hphe/Health-Crisis.
outside the clinic drive vast majority of health outcomes
Unmet Social Needs: At What Cost?
$35 - $7,000 = cost range of comprehensive metabolic panel
2017 Health Leads Inc. 4
Source: Variation in charges for 10 common blood tests in California hospitals: a cross-sectional analysisR. Hsia - Y. Antwi - J. Nath - BMJ Open 2014; 4 http://bmjopen.bmj.com/content/4/8/e005482.full
http://bmjopen.bmj.com/content/4/8/e005482.full
The Impact
Unmet social needs impact health practice
2017 Health Leads Inc. 5
Patients do not receive help paying gas/electric bills be hospitalized
Children with food insecurity more likely to be in fair or poor health from childhood to adulthood
Difficulty paying rent care utilization and emergency room visits
4 in 5 physicians surveyedsaid:
as important to address as their medical conditions
Unmet social needs are directly leading to worse health
They are not confident in their
social needs
1. Frank, D., Neault, N., Skalicky, A., Cook, J., Wilson, J., Levenson, S., Meyers, A., Heeren, T., Cutts, D., Casey, P., Black, Ye2006. 2. Cook J.T., Frank D.A., Berkowitz C., Black M.M., Casey P.H.., Cutts D.B., Meyers A.F., Zaldivar N., Skalicky A., Levens Journal of Nutrition 2004; 134:1432- re Among Low- f the Robert Wood Johnson Foundation in Fall 2011 among 1,000 physicians, of which 690 were primary care physicians and 310 were pediatricians.
We envision a healthcare system that
needs as a standard part of quality care.
2017 Health Leads Inc.
The Health Leads Vision
Our Clinical Partners
2017 Health Leads Inc. 7
Plus, more than 200 provider organizations
that have participated in
other HL engagements
http://www.bmc.org/http://cchealth.org/medicalcenter/http://www.dimock.org/https://healthy.kaiserpermanente.org/html/kaiser/index.shtml
Our Direct Service Approach
Clinical Communication
2017 Health Leads Inc. 8
Follow-up
Resource Referral & Plan
Intake
Screening