Improving the 'Culture of Health' Helps Patients, Experts Say

WASHINGTON -- Accountable care organizations (ACOs) and other players in the healthcare system need to look after patients' non-medical needs if they want their health outcomes to improve, several speakers said Thursday at a briefing on the "Culture of Health" sponsored by Health Affairs.

"The culture of health is about meeting people's needs to attain health and well-being," Alan Weil, editor-in-chief of Health Affairs, explained at the start of the briefing. "And if there's one thing we heard this week [in the election], it's that there are a lot of people in the country who don't feel like their needs are currently being met to provide them with the well-being that they think is warranted given the work that they do and the efforts that they make, and pulling those things together in the context of culture is important for us as we think about health and healthcare going forward."

Taressa Fraze, PhD, research scientist at the Darmouth Institute in Lebanon, N.H., presented her group's study on what some ACOs are doing to help meet their members' non-medical needs. Fraze's study, like the others presented Thursday, appears in the November issue of Health Affairs.

Fraze's group interviewed leaders at 32 ACOs and found that 16 of them were working to address patients' non-medical needs. Housing instability, food security, and transportation were among the most common needs addressed, with various methods being used for each.

For example, an ACO might discover that a patient wasn't taking her diabetes medication because it needed to be refrigerated and she didn't own a refrigerator; the plan would then find the funds to buy her one.

In the transportation area, "ACOs in areas with high-quality public transit typically relied on existing infrastructure," Fraze and colleagues noted in their article. "For example, some ACOs gave transportation passes to patients before their appointments. One ACO provided monthly bus passes -- which could be used for any transportation need -- to all patients who had four or more medical visits per month."

ACOs in suburban or rural areas had more challenges with transportation. One rural ACO provided transportation services through an external for-profit transportation company. The ACO paid the company a per-member-per-month rate. Another ACO in an urban area with poor public transportation was considering developing a mobile device application that would allow patients to request transportation from local drivers, who would be paid by the ACO.