UnitedHealthcare's Catherine Anderson explains how community partnerships can improve care beyond the doctor's office.
Fully 80% of an individual's health is determined by what happens outside a doctor's office. So if it really takes a community to raise a healthy person, what is the best way forward for the health care industry? Catherine Anderson, Senior Vice President of Policy & Strategy with UnitedHealthcare Community & State, joins the podcast to explain how the health care industry is working on a community level.
SPEAKERS
Ira Apfel, Catherine Anderson
Ira Apfel00:05
Hello, and welcome to UnitedHealth Group's Weekly Dose Podcast where we'll get you up to speed on the latest trends shaping the future of health care. I'm your host, Ira Apfel. This week we're talking about the health care that occurs outside a clinical setting. According to the National Academy of Medicine 80% of an individual's health is determined by what happens outside a doctor's office. As it turns out, there are specific local, underlying causes that create complex health challenges and barriers for people, including lack of safe and affordable housing, healthy food and financial stability. So if it really takes a village, or in this case, a community to raise a healthy person, what is the best way forward for the health care industry? Well, working with communities and community-based organizations is one way to address these so-called social determinants of health that can have an outsize impact on an individual's health. Joining me today to discuss community-based health care is Catherine Anderson. Catherine is Senior Vice President of Policy & Strategy with UnitedHealthcare Community & State. She's going to explain how the health care industry is working on a community level, and what UnitedHealthcare is doing to address this situation. Well, Catherine Anderson, welcome to the podcast.
Catherine Anderson 01:22
Thanks. It's great to be here.
Ira Apfel01:25
So let's start with that 80% number, the best estimate is that 80% of an individual's health care is determined outside a doctor's office, can you explain what that means and what it encompasses?
Catherine Anderson 01:37
Absolutely, it encompasses everything else in our lives. If you think about where we live, our education, whether we have availability of food, whether we can, whether there's transportation, whether we have our own car, or public transportation available to us, it's all of those other things. Even internet connectivity, frankly, is one of the super determinants at this point, because we're so dependent as a society on being able to connect to the internet, all of those things make up the 80%. And obviously, they're different for each person. But if you have unstable housing and can't get healthy food, it's almost impossible to have healthy outcomes or a healthy lifestyle or achieve health. And so it's those components that, quite frankly, make up the majority of a person's health and drive the 80%.
Ira Apfel02:33
I was really surprised to hear that number. I didn't think it would be that that large, because when you think about it, you just think of health as I go to my doctor's office, my doctor gives me prescription or whatever or physical. It's a pretty astounding number. No?
Catherine Anderson 02:50
Absolutely. And it's interesting, is there a lot of different models, but they all come up to about the 80% mark. And it makes a lot of sense when you take a step back, because how often are we in our doctor's office, and while we might take a daily med, to keep us healthy, and control our high blood pressure as an example, if we aren't able to address those other things like getting healthy food, that blood pressure med is only going to be so, so successful. And so it really takes all of us start to think very differently about how do we help people achieve health? And we have to take all of those other components into consideration.
Ira Apfel03:32
Yeah, I was going to say, it must be difficult, for example, for physician because a physician is trained to you know, prescribe medicine and do a physical or to have you to change that way of thinking to, you know, saying, well, what's going on outside the doctor's office. So how can we dig down and being investigated? That must be a real paradigm shift for the entire industry
Catherine Anderson 03:59
Huge paradigm shift. And what's interesting is several years ago, that there was an introduction of billing codes are called z codes in the physicians ability to Bill an ICD 10. And they are now included, and a physician can actually create a diagnosis, if you will, of housing insecurity. But the challenge is for many providers that I've talked to, they're somewhat reluctant to create a diagnosis of housing insecurity and not have a solution for them. And if you think around traditional fee for service models, those doctors, you're spending 15 minutes with a patient if they're lucky, and then to have to think about how do you address some of those challenges when in many instances there just isn't a solution on the other side, and I would say that's probably why we haven't seen a great uptick in the adoption of Physicians coding for those sorts of social needs. I think it's both a change in culture, and then the reality of whether there are actually services there to support their patients.
Ira Apfel05:12
So one of the things that UnitedHealthcare is doing is they're looking more at local and community-based partnerships. Before we dig deeper into what, specifically UHG is up to what is the overall Vantage benefit of working with local and community-based partnerships, to address the social determinants of health
Catherine Anderson 05:37
Each community is different. And if we were to try to institute something on a national level, or even on a regional level, it will fall short because there's one community might have a significant food desert, where there's no availability of food, and another community could have no public transportation. And if we're trying to solve all of the problems without real deep community involvement, we're going to fall short. It's almost like, you know, spreading peanut butter really, really thin. across all of the problems, we're just not going to actually get to the root cause of why certain communities are having one challenge or another and then creating the solution that goes to that root cause.
Ira Apfel06:25
So give me an example of how this would work how this would play out in real life, this working with a community-based organization or just with a local community in general.
Catherine Anderson 06:36
So we've launched a model where we use data to help us understand what the challenges are from what we can see in any given community. And we use community data that's publicly available understanding where the greatest challenges are using something known as a deprivation index. And then also looking at data that we have available through claims, we can understand a high prevalence of specific diseases like diabetes, we can also see patterns for high emergency room utilization for childhood asthma attacks, as example. So by putting all of that data together, we are identifying specific communities based on what we think the challenges are. And then we're working directly with community partners to validate those problems really are the problems that the community is feeling, understand why those they're having those challenges, and then asking the communities to help us solve them. Again, it's really around understanding that we can't possibly know from our vantage point, why a community is having a high prevalence of childhood asthma attacks. They really the community is much better suited in helping us understand why that is, and then also helping us think about how to solve for those problems.
Ira Apfel08:02
When you approach a community or community-based organization with some data, that seems promising, in the sense that it is identified some kind of pattern of problem do they embrace you with welcome arms or with open arms? Or do they say, you know, what, what's a health care organization doing helping out? How does that really play out?
Catherine Anderson 08:28
It's really interesting. And it's a fantastic question. When we started doing some of this community work, it really started in a model in Honolulu, Hawaii. And I was reluctant. I didn't think that the community would engage with us and the community partners would engage with us, I thought that they would be somewhat suspicious of us, quite frankly. And what we've learned so far, almost universally, is that there is certainly a place for playing a convening role bringing partners together, even though they might know each other. They're not often working together toward a shared need. And we've also learned that there is a lack of data across the board for organizations to truly understand what's going on. Another example, we've been working with public housing authorities in several states for a few years now. And the public housing authorities have no access to health care data, so they have no idea what could be happening for the people that live in their in their units. And they don't know how they could improve their health through pretty simple interventions from a housing perspective because they simply don't have access to data.
Ira Apfel09:47
So if I'm hearing you correctly, it sounds like UHC role here is they're bringing data. They're being the conveners there they're perhaps even bringing together stakeholders that didn't know that that each other existed. To create a larger, larger community, if you will to address a problem, is that correct?
Catherine Anderson 10:07
That's exactly right. And that's what we are calling UnitedHealthcare Catalyst. It's really the data, bringing the partners together as a convener. And we're also making investments toward the solutions that the community partners identify.
Ira Apfel10:22
We've kind of backed into the new UnitedHealthcare Catalyst solution that, you know, I wanted to talk about initially. So let's break it down. What is UHC Catalyst? And how does it help? And I know it's pretty new. So what are its goals?
Catherine Anderson 10:37
Yeah, it's really new. We launched it at beginning of 21. We funded some of it at the end of 20, but really started convening our partners in 21. And the goal was really to test whether what we'd learned from our work in Hawaii, whether that was an anomaly or whether it was something that we could actually scale to other communities, and replicate the same process to bring partners together and inform decision making and solution development through our data, but also being really intentional about bringing the partners together into your earlier point. In many instances, there are people that they've worked with all the time. And then there is other instances where they've never sat around the table with each other. And so it really is a unique opportunity to bring people together. And our goals of catalysts are really multiple goals. First and foremost, the underlying hope is that through the work of all of the catalyst models that will be reducing health inequity, and really focused on overcoming the disparities that drive to that 80%, particularly for low-income individuals. And that we will solve specific problems that are unique to each community. So whether it's improved maternal outcomes, or reduced food insecurity, we will be measuring against the specific initiative that each catalyst decides to focus on. And we'll be looking at outcomes. And I think, depending on what the focus areas, we'll certainly see some of that pull through and improved utilization. So if you think about maternal outcomes, we know that we can look at that because it's time limited, and we can see whether we're making a difference or not. Some things are going to be harder and longer term, like reducing the prevalence of diabetes in in communities that will that's a generational shift. And so each one of the catalysts will have a very specific metric that we're measuring to over the course of three years.
Ira Apfel12:50
What is your hope? And what is UnitedHealthcare's hope, just for the idea, the concept of community-based health collaboration, in general, where do you envision it a year or five from now it sounds like it's a relatively new idea. That's just taking hold.
Catherine Anderson 13:09
Two things one is, is a as an internal is an internal hope, from my perspective, and what I hope will achieve from catalyst is really understanding the power of communities, and to be really mindful of and demonstrate efficacy of what it looks like when you enable a community to solve its own challenges and create sustainability for those solutions. And then secondarily, if we think more broadly, it really is around enabling communities to sticks that are solved for at least part of that 80% that stands in people's way. And, and I believe we'll be able to track those ships. In relatively short timeframe. these are these are, in many instances require some thoughtfulness and overcoming some generational challenges in many of the communities. But I do believe that we'll be able to see shifts in improved outcomes over the course of each catalyst.
Ira Apfel14:19
Well, Catherine Anderson Singh, thank you so much for joining us today.
Catherine Anderson 14:23
Absolutely. It's been my pleasure. Thank you.
Ira Apfel14:26
That's it for this episode of UnitedHealth group's Weekly Dose Podcast. Don't forget you can now subscribe to the weekly dose on Apple podcasts and Spotify. Thanks for listening and have a great rest of your week.