Social Enterprise: Health Leads
Social Entrepreneur(s): Rebecca D. Onie
Retool common practices in emerging markets – such as alternative healthcare workforces – for developed country contexts and, in the process, redefine what constitutes healthcare and who can provide it.
The Innovation Explained
US primary care physicians are overwhelmed with patient caseloads, especially in low-income areas, spending as little as 13-15 minutes per patient. While these visits are adequate to generate a diagnosis – asthma, say, or diabetes – and prescribe a particular course of treatment, the fundamental drivers of patient health are left unaddressed. Can the family afford adequate nutrition? Have their heat and water been shut off due to lack of payments? Have they been evicted from their home? “Physicians are fully aware that addressing these basic resource needs is equally if not more important than any prescription they can give,” said Rebecca Onie, Co-Founder of Health Leads. “But they say, ‘We weren’t trained for this. We don’t know how to secure housing for our patients. We just don’t have the capacity in our clinics to address those needs.’”
Health Leads set about to change this, embarking on a similar path to well-known models such as Partners in Health in Haiti and Associao Saude Crianca in Brazil, which tap into a large workforce of community health workers to complement physicians’ care. In the Health Leads model, that workforce is the student population in local colleges and universities. “It turns out that if you map the density of [low-income] Medicaid patients against the density of college students in cities across the country, those two populations line up,” said Onie. “And it turns out college students are the perfect workforce: they are energetic, tech savvy and tenacious at information retrieval.”
Health Leads’ student Advocates, as they are known, undergo a competitive recruitment and training process on college campuses, committing up to 10 hours per week for a minimum of one year. The Advocates are stationed in the waiting rooms of Health Leads’ partner clinics and, after an initial needs assessment, help patients access any of the 50 basic resource needs relevant for their circumstances, such as food assistance, childcare vouchers, GED programmes – even negotiating with the utilities company to get their heat turned back on. Advocates follow up on a weekly basis until the patients have secured the basic resources they need. Last year, Health Leads’ 1,000 Advocates served nearly 9,000 patients and their families, servicing 21 partner clinics in six cities.
Why This Matters
Both developing and developed countries alike face constraints in delivering high quality healthcare – such as a limited number of trained physicians – even as pressure mounts to improve health outcomes while keeping costs manageable. Managing acute health episodes among low-income populations rather than focusing on prevention by addressing underlying root causes is widely recognized as an important driver of healthcare costs.
Addressing these systemic challenges “isn’t about more money,” said Onie. “It’s about expanding our definition of what healthcare products are, re-imagining the clinic as a place not only to treat illness but to prevent it, and creatively deploying alternative workforces.”
Look to emerging markets for solutions and practice reverse innovation. “In the global health context, it’s pretty much taken for granted that traditional medical care will ultimately be ineffective unless you simultaneously address the social context of patients’ lives,” said Onie, citing models in Latin America, Africa and elsewhere that cope with a shortage of doctors and nurses by training community health workers. “There are countless models that re-imagine healthcare providers in a more expansive way. We are just one of the few doing it in the US.”
Leverage existing resources in new ways. As Onie recalled, “We asked ourselves, ‘How do we cost-effectively expand the capacity of existing clinics serving low-income patients?’” Regardless of the issue you are trying to solve, she recommends “identifying the untapped human and physical resources that exist already, and figure out how to utilize them in new and unanticipated ways to improve outcomes.”