Anna Spencer, MPH

September 12, 2019

Nothing about us, without us. Human-centered design tells us that in order to develop effective patient care models, patients must be at the “drawing board.” Yet, while many health care systems recognize the intrinsic value of partnering with patients and communities, they often struggle to meaningfully and effectively do so.

The barriers for health care systems to engage communities and their members are many, including a lack of established relationships and trust, divergent health priorities and motivations, the power imbalance between well-funded health care organizations and typically under-resourced community-based organizations, and differences in culture. These factors can pose an even bigger obstacle for populations with complex health and social needs who are often disenfranchised, making authentic engagement even more challenging for health care systems serving these communities. This type of connection and collaboration, however, is critical in order to fully understand the needs and priorities of underserved communities and address community-level drivers of health outcomes.

Community Partnership Pilot

To better understand this issue, the Center for Health Care Strategies (CHCS), through support from the Robert Wood Johnson Foundation and as part of the Complex Care Innovation Lab, launched the Community Partnership Pilot (CPP). This 18-month initiative is identifying best practices for engaging community members, particularly those with complex health and social needs, and building effective partnerships between health care systems and the community. Working with two competitively selected sites, the project is designed to gather best practices for:

  • Identifying community priorities;
  • Obtaining and integrating consumer input;
  • Designing and implementing sustainable community-based efforts to address consumer-identified health and social needs; and
  • Understanding and collectively addressing equity challenges.

The two pilot sites — Hennepin Healthcare and Los Angeles County Department of Health Services’ Whole Person Care program — are considering a range of evidence-based consumer engagement strategies to achieve project goals, including:

  • Community-Based Participatory ResearchAn approach to research that equitably involves community members, organizations, researchers, and others in all aspects of the research process, with all partners contributing expertise and sharing in the decision-making and ownership.
  • Human-Centered Design – Also known as design thinking, is an approach to solving complex problems that empower an individual or team to designing products, services, systems, and experiences that address the core needs of those who experience a problem.
  • Results-Based Accountability – A strategy to help communities and organizations get beyond talking about problems to taking action. It uses an outcomes-based approach to assess how much was accomplished, how well it was accomplished, and whether people are better off.
  • Collective Impact – A process that uses a structured form of collaboration to gain commitment from individuals of different sectors to coalesce around a common agenda for solving a specific social problem at scale.

Ultimately, the goal of CPP is to use these strategies to better understand how to effectively engage consumers and communities and use their insights, along with health system resources, to design and deliver services that are responsive to consumer needs and support improved health outcomes. Following is a look at each of the pilots:

Engaging Immigrant Populations to Address Mental Health Needs

Hennepin Healthcare, a Minneapolis-based safety net health care system, is using this pilot to better understand and address the barriers to accessing mental health care that foreign-born Somali and Mexican communities experience. These communities have markedly low rates of mental health service use, and the Hennepin team will engage with community members to understand why and how to address it.

Working with Upstream Health Innovations, a division of Hennepin Healthcare that uses human-centered design to empower patients and partners with the community to build capacity, the project will: (1) conduct one-on-one interviews with community members to understand perspectives on mental and emotional wellbeing; (2) analyze interview findings collectively with community members; (3) identify community-based solutions to issues; and (4) implement and test pilot solutions. Through a “train the trainer” approach, partnering community-based entities will also learn human-centered design methodology to equip them to lead similar processes in the future.

Access to Care Inside and Outside the LA County Jail System

Whole Person Care (WPC) is a California-wide initiative designed to increase the coordination of physical, behavioral health, and social services for high-risk Medicaid beneficiaries. Through CPP, the Los Angeles County WPC team is engaging formerly incarcerated individuals and their communities to: (1) better understand the reentry population’s experience in accessing health services and identify opportunities to improve these services both within and outside the correctional setting; (2) identify regional gaps in services; and (3) use human-centered/community-driven initiatives to improve health outcomes for the reentry population.

As a first step, LA County WPC will convene a Reentry Health Advisory Collaborative to facilitate communication between health care systems and community partners, and develop innovative solutions for post-release care coordination. The Advisory Collaborative, which will include current or formerly incarcerated persons or family members or friends who have been impacted by the justice system, will provide input on: (1) capacity building of community organizations to support continuity of health and social services on reentry; (2) the equitable distribution of local funds to culturally competent providers who are serving the reentry population; (3) community asset mapping and a gap analysis of community resources that address the social determinants of health; and (4) effective delivery of primary and behavioral health care services in community and correctional settings.

Sharing Lessons for Engaging Consumers and Communities

Integrating consumer experience and voice into health-system interventions is crucial to ensuring that health care systems design and deliver services that meet community needs. These pilot projects will uncover valuable lessons about how to do so, and CHCS looks forward to sharing the insights gleaned from these efforts in the months to come.

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