ProMedica s Journey: Addressing Hunger as a Health Issue Randy Oostra, DM, FACHE President and CEO ProMedica
2 ProMedica is... Community-based Mission-driven Not-for-profit Participative culture Governance & Employee Strategically-focused Financially sound
Our Mission To improve your health and well-being. Our Values Compassion Innovation Teamwork Excellence Our Vision Building healthier communities, one life at a time, through safe, high-quality services and exceptional experiences 3
Healthcare is experiencing necessary industry change that will result in significant impacts on: Reimbursement Access Capacity Inpatient care Physician compensation Increasing physician employment Price Brand importance The result is transformational change 4
How did we get here? 1965 Medicare and Medicaid established 1965 Diagnosis Related Groups created 5% 1970s HMOs created 1980s Healthcare infla<on outpaces na<onal GDP 1993 Clinton Health Security Act universal health care, employer model 1997 Balanced Budget Act Reimbursement reduc<ons for Medicare 2010 Affordable Care Act Today 15 million healthcare employees 2023 9.2% 12.5% 17.6% 19.3% 5
Where are we headed? Health care has evolved over the last 50 years Healthcare costs are a significant issue with the general public o It is the No.1 cause of bankruptcy No liquid assets Medicare will grow from 49 to 79 million Medicaid will grow from 60 o 95 million More primary care physicians needed Did ACA really change model? Future: Popula<on Health = Social Determinants 6
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What is Population Health? The health outcomes of a group of individuals, including the distribution of such outcomes within the group. David Kindig, M.D. University of Wisconsin Madison School of Medicine Greg Stoddart McMaser University, Hamilton, Ontario By embracing a mission of caring for uninsured and indigent patients, a system also adopts a broad definition of the population whose health it intends to manage. 8
9 Changing World of Health Embracing Change Refocus on Mission Community Needs Social Determinants Focus Refocusing of ProMedica Beyond Our Walls Role of Hospital/ Healthcare Systems Government Departments USDA HHS NIH Alliance to End Hunger Bread for the World Share Our Strength Stakeholder Heath AARP Founda<on CDC Founda<on Partnership to Fight Chronic Disease Hunger as a Health Issue Hunger Summits Access Screenings Food Pharmacy Obesity/ Nutri<on
Its not about just what happens inside our four walls 10
Public Health Care 11
A need emerges Through our community partnerships, the link between obesity and hunger became apparent. Many overweight/obese individuals lack access to high-quality, nutritious foods at affordable prices Hunger induces irregular eating patterns which can lead to overweight and obesity Likewise, a strong link between hunger and health exists across the age, economic and social spectrum. 12
Economic Impacts of Hunger The overall cost of hunger to our nation amounts to at least $167.5 billion. Michigan s hunger bill is $5.51 billion Ohio s hunger bill is $6.97 billion The healthcare costs alone related to hunger nationwide are $130.5 billion a year. $4.3 billion in healthcare costs to Michigan $5 billion in healthcare costs to Ohio The annual cost of hunger to every U.S. citizen is on pace to amount to roughly $42,400 per citizen over a lifetime. 13
Hunger in our Community 14
15 The moral imperatives of social determinants meets the economic crisis of healthcare.
Current Situation: Of 5,000 established hospitals in the U.S., 3,000 are not-for-profit. Industry Estimates (Decade) - $200 billion in hospital construction - $350 billion in information technology - $14 billion in marketing $762 billion in net patient revenue in 2012 16
17 A 2011 report by the Robert Wood Johnson Foundation found that while 85% of physicians surveyed said that their patients social needs were directly contributing to their poor health; only 20% felt confident in their ability to help address their patients social concerns.
Who owns the problem? America s opinion in a recent Tyson Foods and the Food Research and Action Center report: 75% of respondents from across the political spectrum believe assistance to hungry people is the responsibility of government, not charitable organizations. A strong plurality of respondents (48%) believe we should be spending more to address the hunger problem. A possible explanation: 62% of those surveyed believe that reducing hunger in the U.S. would significantly reduce public healthcare spending. Only 36% agreed that they personally have more than a fair amount of responsibility to help address hunger. Source: Hart Research/Chesapeake Beach Consulting report 18
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Community-based solutions Food Reclamation 200,000 pounds collected since inception = 125,000 meals Employee and Community Food Drives ProMedica Advocacy Fund Just completed year 6 for RFP Average of $300,000 given annually 20
Community-based solutions Come to the Table Electronic Newsletter ProMedica: Revealing Hunger, photography exhibit Philanthropy: Employee Giving - $65,000 in 2013 School breakfast/lunch/summer meal promotion 5K Walk/Run benefitting local hunger relief organizations 21
Nutrexity A board game for students in grades 2-5 focusing on nutrition, exercise and community 22
Clinical solutions: Research study Three physician practices screening patients for food insecurity using validated screening questions: Within the past 12 months we worried whether our food would run out before we got money to buy more. Within the past 12 months the food we bought just didn t last and we didn t have money to get more. Results indicate in one practice 19% of patients are food insecure These patients show increases in obesity, diabetes, liver abnormalities 23
Food pharmacy: Food insecure patients will receive a referral to the food pharmacy Patients provided with healthy food for themselves and their family Can return to the Food Pharmacy once every 6 months before needing a new physician referral Information entered into medical record for follow up at future physician visits Nutrition education provided by a registered dietitian 24
In-patient screening Several hospitals are screening in-patients for food insecurity in using USDA screening questions Food insecure patients are provided with emergency care package and community resources upon discharge Program to be expanded system-wide Added food insecurity screening questions to Community Health Needs Assessments Screening questions now built into Epic foundational IT system 25
Ebeid Institute for Population Health $1.5 million philanthropic gift Food market Teaching kitchen Job training/career skills Financial literacy classes Parenting classes Nutrition counseling Diabetes education Block by block community empowerment/improvement 26
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A Call to Action 28
29 Health care must have a permanent seat at the table Refocus our industry s role in Public Health Build hunger screening ques<on into the pa<ent EHR Build hunger screening into the Medicare value- based reimbursement and require it in all Medicare facili<es
30 Community Health Needs Assessments should be strengthened to include / address the social determinants Add new physician slots requiring them to be primary care based and focus on social determinants
Members of Congress: Challenge healthcare organizations and work with us on shifting our focus from patient care only, to patient health Be Hunger Champions Connect the Dots Hunger is a Health Issue 31
32 We believe a healthcare system should take a leadership role.. Clinically Socially Economically