For many middle-class Americans, yearly physicals and semi-annual dental exams are a given. Regular doctor visits are an expectation, almost a birthright, and certainly not a luxury. But in many communities, especially those that are low-income, health care is not always viewed as a positive benefit.
“I’m afraid of doctors”
Where I grew up—Washington, Georgia, population 4,000—I heard this sentiment from family and friends all the time. People only went to the doctor when they were seriously ill, often heading straight to the emergency room for conditions that would have been easy to resolve if caught earlier. I witnessed loved ones and neighbors—many of whom were insured or covered by Medicaid—die well before their time due to complications from high blood pressure, high cholesterol, type-2 diabetes and other treatable or preventable conditions.
This mindset affected me too. My family had health insurance yet I went through college without a well-woman check-up. And when I went to the dentist for the first time at 20 and learned that I had a cavity in a molar, I had it extracted instead of getting a root canal. It was cheaper and less scary.
As a young internist, I saw a lot of patients who presented late in an illness. And I saw millions of dollars spent to treat conditions that were far advanced unnecessarily. An earlier visit could have saved these patients a kidney, a liver or a foot lost to untreated chronic conditions such as diabetes, high blood pressure and hepatitis.
My takeaway: clearly, something was missing from the health care equation in underserved communities. More significantly, access to coverage was not the paramount issue. Those dollars could have—and should have—been re-directed towards good health education and preventive care. The system was failing in low-income communities.
But why? Many of these patients had health insurance or Medicaid. What exactly was it about low-income communities that led its residents to rely on emergency care and forgo primary care?
3 Issues That Block Access To Health Care
My goal became identifying the barriers to care and solving them—issues that have concerned me since I was a resident. And after spending most of my career treating underserved populations, I believe that there are three broad socioeconomic factors that limit access to proper health care in low-income communities. These were the focus of my recent TEDx talk, Taking Health Care to The Streets, and are as follows:
1. Cultural Myths & Fears: Healthcare is approached differently in underserved areas. Cultural nuances such as reliance on home remedies (think vinegar and garlic for high blood pressure) and unhealthy lifestyles are amplified by a distrust of medications or fear of doctors. Rather than putting faith and confidence in physicians, many patients are filled with crippling anxiety or skepticism that has been engrained in the community psyche.
2. Limited Access to Resources: Conveniences many people take for granted simply aren’t available in low resource neighborhoods, where access to good schools, community center, free gyms, grocery stores with fresh, healthy food and more is limited. Things like transportation and childcare for a medical appointment can be considered a financial hardship. For those who are fearful of doctors, proper emotional support is often unavailable. Faced with all of these obstacles, health care falls by the wayside until a previously treatable condition becomes an emergency situation.
3. Lack of Follow-Up: Studies done at Princeton and Harvard found that the cumulative cognitive load of excessive stress can take a person’s IQ down by 13 points. Fear translates into stress. When people are scared and stressed out, the idea of a follow-up appointment or a visit to a specialist for a health concern can be too much to bear. The result? Health care once again falls by the wayside, and a treatable condition isn’t addressed until it becomes an emergency situation — or worse.
The Solution? An Innovative Healthcare Delivery Model
Recognizing these issues led me to a solution: NextLevel Health, an insurance company focused on helping the underserved access and manage Medicaid services. It combines old-school community organizing with new school tools.
Using those new school tools, we gather data to understand what we call population health. Before we focus on the individual, we must understand the total environment they live in—including cultural and family factors that influence how they approach health care. That means addressing their remedies, myths and beliefs about receiving a diagnosis and engaging the healthcare system.
Armed with that information, we identify a community’s systemic barriers, whether it’s lack of access to transportation, the need for emotional support or a host of other factors. Background knowledge of a community helps us support individuals the old school way—with frequent personal interactions—and get them the resources and care they need in a way that gives them the broadest opportunity for long-term good health and the best outcomes. It involves the following strategies:
3 Keys of Innovative Health Care Delivery
1. Locating, hiring and training locally: We have offices in the communities we serve, and hire and train local residents on what the Medicaid program requires. In turn, this gives us a team that knows how to navigate the community safely, deal with its issues and understand what people have been through. And hiring locally generates much needed community jobs.
2. Forging creative local partnerships: We forge creative partnerships with nonprofits and businesses in the community we serve, from churches, schools and community centers to retailers, service providers and landlords. These partnerships come in handy when we have to help members with housing, transportation, childcare and more.
3. Hitting the streets armed with data and tech: Empowered by technology, our employees are able to gather patient data, track data and identify specific community issues and resources (or lack thereof) and provide our members more effective guidance so they can receive preventive treatment and services.
Chicago and Beyond: Taking It Global
Armed with education, insights and an appreciation for differing mindsets, our NextLevel healthcare delivery model is logical, achievable and most significantly—repeatable. It can be implemented anywhere, and save communities money as healthcare costs are allocated upstream to preventative care instead of downstream to emergency rooms. If this kind of system had been in place when I was growing up, I would still have that molar and many of family friends who died in their 40s from preventable conditions would still be alive today.
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