In our latest research, You are what you treat: Transforming the health care business model so companies—and people—thrive, we set out to discover what makes health care organizations capable of successfully addressing the drivers of health (DOH). In short, the answer lies in their business models.
To better understand what allowed certain organizations to succeed in their DOH efforts, we interviewed leaders successfully addressing DOH in their work. CommonSpirit offers one innovative model leaders can learn from.
CommonSpirit is a faith-based health system and one of the largest non-profit health systems in the country, created by the alignment of Catholic Health Initiatives and Dignity Health. It includes over 1,000 primary care sites and 140 hospitals in 21 states. With the goal of “delivering high-quality care with humankindness to communities across America,” CommonSpirit focuses on advancing health equity, improving population health, and innovating care delivery. CommonSpirit’s business model allows the organization to deliver on these goals. Let’s look at each of these business model components to highlight a few of the organization’s keys to success.
CommonSpirit offers two distinct but connected value propositions: one to their patients, and one to the communities they serve. For patients, they offer a value proposition to care about the whole person. As part of this offering, they connect patients to resources that enable healthier lives. For the communities they serve, they are a driver of community change and resource improvements. .
CommonSpirit’s dedication to addressing total health is made evident in that health equity is one of their strategic priorities. To support this priority, they have a “Total Health Roadmap,” which outlines their plan to improve patients’ lives by focusing on total health. This includes CommonSpirit’s three-pronged approach to addressing drivers of health for patients, communities, and providers:
- For patients, this means assessing patients for DOH needs, connecting them to resources, and following up on their progress.
- For communities, this means engaging with community organizations, to help develop plans to close resource gaps while also addressing the role of health care in community development.
- For providers, this means ensuring all levels of providers have the resources they need to serve patients’ total health, such as developing a framework for practitioners to use to advance health equity in the community.
Resources and Processes
To support its DOH efforts, CommonSpirit leverages its partnership ecosystem, connected by differing tech platforms depending on the community. This ecosystem is made up of a number of community based organizations (CBOs) as well as start up partners who support DOH efforts. The network of partners and the tech platforms that enable them to manage those connections, allow CommonSpirit to both support community organizations and keep track of the work being done to address patients’ DOH needs. CommonSpirit does not just screen for social needs, but is able to refer patients to specific resources and track their progress in accessing those resources. This helps to ensure patients receive the support they are seeking.
CommonSpirit relies on community and population health teams to form and maintain connections with community organizations. These teams also support community organizations in improving their services. For example, we learned in our interviews how these teams helped community based organizations learn how to bill Medicaid for services, enabling the organizations to benefit from a new revenue stream instead of solely relying on philanthropy.
A key member of these community health teams are Community Health Workers (CHWs). CHWs are community members hired as a bridge between medical care and the broader community, supporting CommonSpirit’s community and population health efforts. CHWs at CommonSpirit act as the intermediaries between providers and the community, helping patients navigate the health system, connect with community based organizations, and improve provider understanding of patients’ DOH needs. Because they are hired from the communities CommonSpirit serves, CHWs often have a deeper understanding of patient concerns through shared lived experiences; by embedding CHWs in CommonSpirit care teams, these concerns are reinforced and addressed when developing patient care plans.
Every patient at CommonSpirit receives a social needs screening, regardless of whether they’re seen in a primary care setting or the emergency department. This screening process, while standard practice, is different in different communities. In some locations, like Des Moines, Iowa, patients are screened digitally through a patient app. In others, CHWs call patients before their appointments and walk them through the screening. In all cases, CommonSpirit’s providers are educated on the importance of DOH needs screenings and how addressing these needs is a key aspect of a patient’s total health. This education supports provider investment into DOH screenings.
CommonSpirit uses a variety of tech platforms to assess patients’ social needs and refer patients to community resources, such as UniteUs, NowPow, and Aunt Bertha. These tools support the collection of data from patient screenings, and aid providers in managing the work done by CHWs to address patient needs. The screening tools vary as well, with some screening taken from the PRAPARE toolkit and other screening tools modified from there. Flexibility is key when serving a large population, and CommonSpirit exemplifies this capability in their efforts to address patient and community-specific needs around drivers of health.
To highlight the value of their DOH efforts, CommonSpirit captures measures specific to patient DOH. One example is a count of how many needs assessments they’ve performed. Another is the number of referrals to community resources that result in a patient seeking those resources (also known as a closed loop referral).
These process measures are important, as CommonSpirit is transitioning towards more value-based contracts, which incentivize improved patient health outcomes. In particular, for their enhanced care management for higher-risk populations, CommonSpirit is paid a lump sum per member per month to provide for all care needs. Beyond that, 2.5 million lives are cared for under some form of value-based payment contract, and CommonSpirit has one of the most successful shared savings programs in the country. Their total health approach and dedication to supporting patients’ DOH needs is critical to this success.
Funding for DOH efforts varies widely by organization, but as we discovered in our research, many organizations rely on philanthropy. CommonSpirit’s CHW program is primarily funded in this manner, though some markets cover the investment with a Medicaid Innovation waiver. As expected in an incumbent organization, the return on investment of CommonSpirit’scommunity health efforts plays a large role in how their efforts are viewed. After seeing a positive return on a CHW program in Arizona, CommonSpirit moved to make CHWs full time employees throughout the system.
CommonSpirit represents one example of a large health system seeking to address DOH for their patients and communities. A number of aspects of their approach—such as integrating DOH into their strategic priorities, investing in new resources and processes required to address DOH, and enhancing their value-based contracts that support DOH efforts—enable the organization to improve patients’ and communities’ health and lives.