With Americans racking an estimated $140 billion in medical debt, it’s hard not to question where the healthcare ecosystem has failed.
Employers are especially under pressure to
Lynn Carroll, chief operating officer and head of strategy at healthcare administrative solutions company HSBlox, suggests that employers look at the foundation of healthcare — namely, where consumers access care. One of HSBlox’s solutions, CureAlign, partners with self-insured employers to create localized healthcare networks called community care networks, in an effort to shift away from the traditional healthcare ecosystem.
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“We are building a platform that aligns traditional medical networks and community-based organizations, such as social service agencies,” says Carroll. “There's sort of a disconnect about how those two can be melded together and brought into a common network.”
This means focusing on making a community healthier, and in turn addressing social determinants that may point to harmful conditions in a local environment, such as a lack of safe housing, air and water pollution and access to nutritious foods. Large networks and volume-based care — with healthcare providers that have no connection to the patient's community, let alone the patient — may be doing more harm than good, explains Carroll. However, it may be challenging to connect an existing healthcare system with local social services; since many community organizations are not-for-profit, their existence depends on their funding status.
“They may be here today and gone tomorrow,” Carroll says. “But if they are directly contracted to become participants in the network by payers or employers within the community, these organizations will have staying power.”
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As a result, social services can be strengthened in traditionally underserved communities while tackling challenges in the community that lead to health problems. For example, if a food bank is getting support within a community care network, it may be able to supply nutritious foods to more people within its neighborhood, addressing health problems that can be caused by malnutrition before they even begin.
The Robert Wood Johnson Foundation cited that social determinants of health can drive as much as 80% of health outcomes. The McKinsey 2019 Consumer Social Determinants of Health Survey found that those who self-reported poor health and a higher rate of healthcare needs were more likely to also report several unmet social needs. Another report from the New Jersey Hospital Association found that the poorest zip codes in the state had the highest rate of individuals with chronic diseases going to emergency rooms for care.
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“Within our healthcare system, we need to consider an approach that keeps folks from having to manage a chronic disease,” says Carroll. “I think if we see employers continue to have an interest in diversity, equity and inclusion, then we’re going to be on the right path.”
Often, health is a result of race, economic class and physical environment. For employers, helping build a community care network could address the Venn diagram of healthcare and DEI. Carroll views this integration of healthcare and community care as a long-term solution to a long-term problem.
“It seems that things tend to take a little longer to solve in the U.S. healthcare system than probably anybody would like,” Carroll says. “But the shift toward direct-contracting and the provision of service within the community that employers are doing is the right approach.”
