Advancing innovations in health care delivery for low‐income AmericansAdvancing innovations in health care delivery for low‐income AmericansAdvancing innovations in health care delivery for low‐income Americans

www.chcs.org  |  @CHCShealth

“Listen First”: Community-Centered Program Design

Putting Care at the Center 2019

National Center for Complex Health & Social Needs

November 14, 2019

11:15 AM ‐ 12:30 PM

www.chcs.org  |  @CHCShealth

Advancing innovations in health care delivery for low‐income AmericansAdvancing innovations in health care delivery for low‐income AmericansAdvancing innovations in health care delivery for low‐income Americans

Welcome &Introductions

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Welcome and Introductions Centering Your Community Spartanburg, South Carolina: Community ConnectionsMaimonides Medical Center: Participatory Action Research

Q&A with Panelists

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Agenda

Presenters

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Jim LloydProgram OfficerCenter for Health Care Strategies

Carey RothschildDirector, Community Health Policy & StrategySpartanburg Regional Healthcare System

Edward StallworthPastorInman United Methodist Church

Anna SpencerSenior Program OfficerCenter for Health Care Strategies

Shari SuchoffVice President, Population Health Policy & StrategyMaimonides Medical Center

Khaalida JonesHuman Subjects ResearcherMaimonides Medical Center

About the Center for Health Care Strategies

A nonprofit policy center dedicated to improving the health of low‐income Americans

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The forces impacting patients’ healthextend beyond clinic walls, and intothe lives they lead, in their towns, churches, and schools

Integrating consumer/community voice into health care program design and delivery is a powerful tool for creating more responsive and supportive systems, and building trusting relationships 

As we look to clinical care through a patient‐centered lens, we can turn a community‐centered lens on program design

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Centering the Community

The importance of consumer and community voice is being increasingly recognized by healthcare stakeholders»RWJF Community Partnerships Pilots»CMMI’s Accountable Health Communities

As the health care system transitions from volume to value, the consumer perspective ensures that we are designing programs that are effective»Increased flexibility in payment; flexibility in service delivery»Value = doing things people care about

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The Value of Community-Centeredness

Discuss with your table:»What does “community engagement” look like to you?

»How are you identifying your communities’ 

»What are some of the barriers and enablers to doing this work?

»How have you/can you translate community need into action?

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Centering Your Community

www.chcs.org  |  @CHCShealth

Advancing innovations in health care delivery for low‐income AmericansAdvancing innovations in health care delivery for low‐income AmericansAdvancing innovations in health care delivery for low‐income Americans

Centering the Community in Practice

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Spartanburg, South Carolina:Community Connections

Spartanburg»Spartanburg County ‐ Population of 306,000 and 13 municipalities City of Inman – population 2,200

»Poorer health outcomes and lower median household income and education attainment levels than peer counties in the state

»A Southeastern manufacturing hub (home to BMW, Michelin, Milliken) situated on the heavily developed I‐85 corridor between Charlotte and Greenville

»While much of the county remains rural, the city of Spartanburg is in a phase of development and growth

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Spartanburg, South Carolina

Partners»Spartanburg Regional Healthcare System»City of Spartanburg»Joint Funders (local United Way and 3 foundations)»Chamber of Commerce»Spartanburg County

Progression »Spartanburg Community Indicators Project (1987)»Road To Better Health Coalition (2008)»Way to Wellville (2014)»Spartanburg Community Health Workers monthly meeting (2018)

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Community-Wide Engagement Efforts

Faith‐Based Community Engagement»Adverse Childhood Experiences and Resiliency building trainings

»Community Resource field trip 

Targeted City Neighborhood Engagement»Northside Voyagers»Highland Community Master Planning

Community Health Needs Assessment and the    Racial Equity Index

CHWs and Peer Support Program Development

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Current Activities

Surprises:»Listening fatigue»Some solutions are simple and build goodwill quickly

Lessons learned: »Invest time and energy in authentic, long‐term relationships»Be open to surprises and willing to tackle them (the cats!)»Use trusted connectors, human capital»Follow up & circle back ‐ repeatedly

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Lessons Learned / Key Considerations

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Maimonides Medical Center:Participatory Action Research

Maimonides Medical Center»Largest hospital in Brooklyn, serving as borough’s tertiary care hub

»82% of patients government‐insured»$200 million in community benefits and investments, subsidizing care and services to under‐served communities and investing in community health initiatives

»Long history of leadership in population health 

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Background

Community Care of BrooklynNetwork of providers working together on Medicaid redesign effort, led by Maimonides

640,000+ attributed Medicaid beneficiaries 4,600+ practitioners, including1,600+ primary care providers

1,000+ Participant Organizations: 

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• 7 Hospitals • 10 FQHCs• 3 IPAs• Behavioral health providers• Social service providers • 70 Community‐based organizations• Health Homes• Substance Abuse Providers• Advocacy Organizations

• Home Care• Skilled Nursing Facilities and other Long‐Term 

Care Providers• Correctional Health Experts• Housing Providers and Advocates• Managed Care Plans• RHIO• Unions• Job Training Providers 

…and 20% of New York State’s Medicaid 

beneficiaries live in Brooklyn (2% nationwide)

Brooklyn Landscape

1.2 million Medicaid beneficiaries

300K residents uninsured

Diverse cultures, languages spoken

Distressed hospitals, providers

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33% of New York City’s Medicaid beneficiaries live 

in Brooklyn

Source: Centers for Medicare and Medicaid Services & NYS Department of Health

Brooklyn Landscape

Brooklyn statistics as compared to the national average –

50%more residents living below the poverty level

23%more residents are unemployed

8%more of residents’ household income goes towards rent

10% fewer residents are uninsured 

% Below Poverty Level Unemployment Rate % of Household IncomeGoing Towards Rent

% of Population WithoutHealth Insurance

NYC 1.34 1.18 1.06 0.93

Brooklyn 1.50 1.23 1.08 0.90

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

Results as C

ompa

red to th

e Nationa

l Average

US Census Bureau Demographic and Economic Indicators2017

NYC Brooklyn

*National Average

Source: US Census Bureau, 2013 – 2017 American Community Survey 

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Participatory Action Research

Includes local residents in research processes that will drive changes in their own communities

Acknowledges local stakeholders’ personal experiences as valid and critical in identifying community assets and implementing action plans

Shifts the power balance by changing who determines needs and solutions

Led by CCB’s Community Action and Advocacy WorkgroupThis image cannot currently be displayed.This image cannot currently be displayed.

PAR and CCB: Context Complex social, economic, and environmental problems cannot be addressed through top‐down, needs‐based development approaches

Recognition that engagement is a two way process and that each community has its unique characteristics and identities

CBO input and collaboration is essential Asset‐based community development based on the knowledge that change is rooted in the hands, hearts, and minds of people

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Participatory Action Research Projects 2016 - 2019

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2016 2017

2018 2019

Brownsville, East New York Bedford-Stuyvesant, Crown Heights, & East Flatbush

Canarsie, Flatlands, Flatbush, East New York, & Starrett City

Sunset Park, Bay Ridge, & Borough Park

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Participatory Action Research Outcomes 2016-2018

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2,500+ Community Members Surveyed

High School, College, and Graduate Students trained in Participatory Action Research

150+ Community Assets Identified 350+

Community-Endorsed Recommendations (i.e. food justice, affordable housing, building local organizing capacity, leveraging anchor institution resources)

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PAR surveys, community feedback sessions and report-backs to the communitygenerate actionable recommendations. Key efforts to date include:

PAR Findings Used to Inform Larger Plans

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Healthy Savings Program: Supporting access to fresh produce in partnership with theNYC Mayor’s Office of Food Policy and the Brownsville Multi-Service Center

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Farm-to-Institution: Developing a farm-to-institution initiative in partnership with theBedford-Stuyvesant Restoration Center

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Fan4Kids: Providing year-round fitness and nutrition education in elementary schoolsin Brownsville and East New York

East Brooklyn Call to Action for Health and Economic Justice: Partnering withNYCDOHMH, labor, CBOs and others to mobilize community members to improvehealth and housing; food and fitness; premature mortality and workforce

EBC2A

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Hydroponic Farms: Partnering with Teens For Food Justice and Brooklyn Sprout toincrease healthy food access and develop community-owned hydroponic businesses

Don’t underestimate the true value of local knowledge  It is key to include community voices at the decision making table 

Success requires time, patience and commitment across the board

Be open to new ideas  Involve elected officials in the conversations Use a consensus‐based approach to decision making It was a galvanizing force to help everyone collaborate on a common project to uplift Central Brooklyn

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Lessons Learned / Key Considerations

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Advancing innovations in health care delivery for low‐income AmericansAdvancing innovations in health care delivery for low‐income AmericansAdvancing innovations in health care delivery for low‐income Americans

Question & Answer

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www.chcs.org  |  @CHCShealth

Advancing innovations in health care delivery for low‐income AmericansAdvancing innovations in health care delivery for low‐income AmericansAdvancing innovations in health care delivery for low‐income Americans

Thank you!

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