Care Redesign
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Depolarizing the Social Determinants of Health (04:35)

How do we shift the national conversation toward whole-person health? Rebecca Onie talked about building a movement around addressing the social determinants of health. Tyler Norris discussed the tools he has used, including funding and large health system influence, to move toward a shared agenda for healthy communities. But how do we align on a shared set of nomenclature? Toyin Ajayi, Chief Health Officer for Cityblock Health, asks Onie and Norris what would work to rename the space and articulate a broad coalition around what health actually means.

“One of the things that is most beautiful about our country is its form of government as a democracy, and that we not only have 50 states but thousands of communities that get to be local experiences,” says Norris, who is Chief Executive Officer for Well Being Trust. One place where it’s important to begin is in seeing what these communities are learning on the ground, with business, government, nonprofit, faith, and community leaders coming together across political points of view, sector, education, income level, and so on, asking, “What is it going to take to create a healthier community?”

Norris, who has been involved in these conversations across the U.S., is “continually struck by the relative commonality of the conversation.”

Do the pattern analysis, says Norris. What commonalities do we see across different communities? What voices are we hearing? And then, “as Republicans, Democrats, Independents, we can start to find courage to talk to our elected leaders who are continually split in their parties and committees that take a party line, to say, ‘We’ve got your back if you’ve got the spine and courage to stand up for what’s happening in our communities.’”

“When we see communities that are producing those outcomes, let’s lift that up and make sure we’re allocating those dollars at the state level and the federal level and let the nation, in its diversity, help shape policy — not a polarized political structure,” says Norris.

Health Leads Co-Founder Rebecca Onie points to North Carolina, which she says in some ways epitomizes the state of the U.S. today, with its Democrat governor and Republican general assembly. “North Carolina is just a fascinating test case because I believe it’s authentically on a path to reimagining its relationship with health,” says Onie.

The prior Republican governor shifted Medicaid to Managed Care, which altered the conversation among providers on the ground about what the economics are of delivering care in a state with high rates of obesity and hunger, for example, against the realities of clinical practice.

North Carolina’s Secretary for Health and Human Services, Mandy Cohen, announced that she would use every policy tool at her disposal “to fundamentally commit to a broader notion of health,” says Onie. As she designs the RFP for payers to compete to be those Medicaid Managed Care organizations, they aren’t allowed in without member-level data about food insecurity, housing, income, etc.

Taking the “opportunity to begin leveraging that, to be able to say and identify, ‘these are communities in which the leading health and health care issue is hunger, not diabetes — it’s hunger,’ the power is to be able to use data to be able to really move that agenda forward,” says Onie.

From the NEJM Catalyst event Expanding the Bounds of Care Delivery: Integrating Mental, Social, and Physical Health, held at Vanderbilt University Medical Center, January 25, 2018.

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