'No one should go hungry': How the Root Cause Coalition is working to change healthcare's priorities

While the influence of social determinants on the individual health of patients seems intuitively obvious, health systems have largely failed to address health disparities within their own communities. However, with the rise of value-based care and population health management, these issues are getting more difficult to ignore, and the Root Cause Coalition formed to help health systems address those issues.

The Root Cause Coalition is a member-driven, nonprofit organization created to take on issues pertaining to social determinants of health like poverty, housing instability and hunger to improve the health of America's disenfranchised communities. Members range from nationally known nonprofits to small businesses and community organizations, and they addresses these issues by engaging communities in collaborative population health projects and deploying the organization's collective influence to inform public policy.

During the Root Cause Coalition's First Annual National Summit on the Social Determinants of Health in Chicago on Dec. 5, Randy Oostra, chairman of the coalition and president and CEO of Toledo, Ohio-based ProMedica healthcare system; and Lisa Ryerson, vice chair of the coalition and the president of the AARP Foundation, discussed the organization's goals for the future and its focus on hunger as a health issue.

"The problem of food insecurity in our land of plenty is in fact a systemic problem, not a problem of individual failure," said Ms. Ryerson. "It's just this simple — no one deserves to be hungry."

One of the Root Cause Coalition's research initiatives, Tackling Hunger to Improve Health in Older Americans, is focused on adults over 50 years of age who experience food insecurity and are afflicted with chronic illness. The study is the result of a partnership with the CDC and is being conducted by the Public Health Institute.

Redefining healthcare success
Mr. Oostra challenged the conventional definition of healthcare success with a comparison PowerPoint slide. The left side showed a health system boasting $3.1 billion in revenue and more than 300 care sites, employing more than 800 physicians, serving 5 million patients annually and consistently generating strong financial ratings and good inpatient and outpatient values. Mr. Oostra concluded that most would say such a system was fairing pretty well.

The right side featured information on a community with some of the fastest growing poverty in the nation and ranked last among 88 counties in the state for infant mortality. A community where 70 percent of adults are overweight and 36 percent of low-income families experience food insecurity. Mr. Oostra surmised that most would say such a community had some troubling issues.

"The left slide is ProMedica and right side is a snapshot of Toledo," said Mr. Oostra. "When you look at this, you're seeing the story of the American healthcare system."

ProMedica is now working to make its community healthier. To reduce food insecurity in northwest Ohio and southeast Michigan, the system has launched a number of successful initiatives, including a food reclamation program — which has provided more than 275,000 meals to needy residents since 2013 — screening patients for food insecurity, sponsoring summer meal plans for children and launching a population health center in Uptown Toledo, an area designated by the United States Department of Agriculture as a food desert. Known as the Ebeid Institute for Population Health, the center opened in December 2015. It provides Toledo's Uptown community with access to a full-service grocery market staffed by neighborhood residents. The center also offers residents access to education opportunities like cooking classes, employment skills classes and financial coaching.

"Kind of the bottom line for us is the view that we need to have as much focus on social determinants as we do on clinical care. Not everybody would agree with that today... especially with all the pressures in healthcare," Mr. Oostra said during the Chicago summit. "But that's kind of what we're driving towards."

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