|
Getting your Trinity Audio player ready...
|
What if healthcare wasn’t just about treating sick people, but preventing illness? At Miami-based Jackson Health System, Barbara Fonte, vice president of managed care and population health, is proving that a proactive approach to caring for vulnerable populations not only improves health outcomes but also saves millions of dollars. And she believes this innovative model could work on a national scale.
Jackson Health System, a public, safety-net health organization with an academic arm connected to the University of Miami Miller School of Medicine, serves Miami-Dade County. Known as the Gateway to the Americas, the region is home to many immigrants, homeless patients, and others who can’t afford healthcare because they’re just trying to survive.
“Jackson Health System’s mission is to build the health of the community by providing a single, high standard of quality care for the residents of Miami-Dade County,” says Fonte. “As a public health trust, we strive to uphold this mission by serving all residents, regardless of their ability to pay. We believe that prioritizing the needs of our most vulnerable citizens, while remaining responsible with public funds, ultimately strengthens the entire healthcare system.”
Fonte explains how this focus led to a critical insight: “We realized that uninsured residents in Miami-Dade County represent the largest group of patients who pose a financial risk to our system. It became clear that serving these individuals is essential to fulfilling our mission.”
That insight led Jackson’s leadership team to apply value-based care strategies to help improve the health of these vulnerable patients. But there are significant complexities.
For starters, the most vulnerable patients often seek emergency room services for nonemergent issues. Federal law requires protection of any patient who enters the ER, and it’s the default point of access for a patient population that rarely has access to routine medical care, follow-up appointments, and managed care.
“We’ve been collecting data on our patients for years,” Fonte explains. “We know which ZIP codes produce the most strokes, heart failure, and diabetes-related illnesses. Why do we continue to propagate ‘sick care’ and wait for patients to show up in our emergency rooms?”
Jackson Health System’s answer to this decades-long question is proactive care.
“We believe that prioritizing the needs of our most vulnerable citizens, while remaining responsible with public funds, ultimately strengthens the entire healthcare system.”
Barbara Fonte
Jackson’s Population Health Program, which Fonte leads, connects patients with preventive care before they experience a catastrophic health event. One of its standout initiatives, a health literacy campaign, enrolled 3,000 patients to address issues like chronic illness and underlying behavioral health issues that complicate patient care.
“Intervention is necessary to help patients navigate a big, complex, and intimidating system, especially for those who don’t have insurance,” Fonte explains. “To mitigate these issues and help ease anxiety, we accompany patients along every step of their health journey, showing them how to make appointments and where those appointments are.”
To validate whether this type of patient intervention was effective, Jackson worked with a national audit firm. The findings showed that for every 100 patients who received a proactive intervention, the health system saved $3 million in avoided costs.
“Once we saw those results, the decision to continue building this program was a no-brainer,” Fonte says. “We continue to work on understanding our target populations and getting to the root cause of these issues so that we can implement long-term, sustainable solutions to improve the health of these patients.”
Partnerships have been instrumental to expanding the model and better supporting the populations Jackson has in common with other groups. Jackson collaborates with local community-based organizations as well as federal organizations like the United States Department of Housing and Urban Development, which labeled affordable housing a crisis in Jackson’s service area and made it a service priority.
One community organization where Fonte has forged ties is the Health Foundation of South Florida. “As a Health Foundation board member, Barbara combines her expertise in population health with her deep passion for the community,” says Loreen Chant, president and CEO of the Health Foundation of South Florida. “Her insights help inform our efforts and foster collaborations between the Foundation and Jackson, aiming to address root causes and improve care in our community.”
By teaming up with local fire departments, emergency medical technicians, the YWCA and YMCA, and other frontline organizations, Jackson can identify individuals working toward economic stability and better health. Jackson hires and trains these individuals, then redeploys them into their communities to assist in outreach efforts.
“This collaboration will elevate the health and well-being of our target community and our patients, while also providing health care jobs to people who are passionate about this cause,” Fonte said. “It’s a win-win.”
These programs are all part of a larger vision that Fonte believes can be replicated nationally. But first, healthcare organizations must understand the importance of proactively building connections in their communities and better understanding the causes of health disparities in their most vulnerable patients.
“We have to drive the conversation with our patients, our clinicians, and our partners,” Fonte says. “On my team, we proudly call ourselves ‘hope dealers.’ We’ve created change, and we’re going to keep pushing.”
