True population health management means taking 'custodial responsibility' for entire communities of people: 5 questions with RWJBarnabas Health President and CEO Barry H. Ostrowsky

"Population health management" is a frequently used term among healthcare executives, especially as the industry shifts its focus from volume of services delivered to prevention and outcomes-based care. But population health management can encompass a broad range of interpretations and initiatives, and such efforts are implemented at varying scales at different health systems across the country.

To Barry H. Ostrowsky, president and CEO of West Orange, N.J.-based RWJBarnabas Health, effective population health management efforts must go beyond simply taking measures to avoid unnecessary emergency department utilization or providing broad interventions for a targeted disease, though he notes these endeavors are still important. Mr. Ostrowsky says to truly manage the health of a community, health systems must identify and address the most significant social determinants of health, as factors like employment, food security, housing and education have an outsized effect on individuals' ability to achieve and sustain positive health outcomes.

Mr. Ostrowsky became president and COO of Barnabas Health in 2010 and president and CEO in 2012. He assumed his current position in April 2016 following the merger of Barnabas Health and Robert Wood Johnson Health System. RWJBarnabas Health is the most comprehensive healthcare delivery system in New Jersey, covering approximately 5 million residents, or more than half of the state's population. It is also the state's largest employer.

Under Mr. Ostrowsky's leadership, RWJBarnabas Health has launched a series of initiatives aimed at supporting the economically disadvantaged in Newark, N.J., including nutrition and employment programs, which are pilots to be introduced in other New Jersey communities. He was also a member of the American Hospital Association's Task Force on Ensuring Access in Vulnerable Communities, where he helped the association identify issues and design solutions that can be replicated in vulnerable communities across the nation.

Here, Mr. Ostrowsky took the time to answer Becker's five questions.

Question: What is RWJBarnabas Health doing to address social determinants of health in the communities it serves?

Barry H. Ostrowsky: Our first meaningful approach began in Newark, a city that encompasses highly skilled and professional individuals but unfortunately also has a vulnerable community that suffers from chronic unemployment, poor housing and food insecurity. We chose to focus on the issue of chronic unemployment initially because helping people find jobs and training them to maintain employment can help to address many other social determinants of health. For instance, when a family has an income, they are in a better position to have safe housing, buy healthy food and are less likely to develop behavioral health challenges.

Through one program, we provide intensive job training and job opportunities. We are also investing in local companies that are typically minority owned. These companies will provide us with goods and services while increasing the opportunity to hire additional Newarkers. We are also working with our vendors to hire people from vulnerable communities and reviewing our supply chain strategy to create additional jobs in Newark. Finally, we've invested in an entrepreneurial incubator that will support new ideas and businesses, provided those businesses remain in Newark and commit to hiring Newark residents.

Q: How are you making a difference in Newark's economically disadvantaged South Ward and all of Newark? 

BO: While we have many initiatives, one of the most exciting is The Beth Greenhouse, located at Newark Beth Israel Medical Center and Children's Hospital of New Jersey, which provides access to fresh, nutritious affordable produce to residents of the South Ward and surrounding communities. It also provides on-the-job training, internships and employment opportunities and supports health and wellness activities. We expect to replicate this greenhouse in other vulnerable communities such as Jersey City.

Q: What types of issues did you identify through your work in the American Hospital Association's Task Force on Ensuring Access in Vulnerable Communities? How have your findings influenced initiatives at RWJBarnabas Health?

BO: I came to that task force with a bias that urban vulnerable communities are most desperate for healthcare services and programs designed to address social determinants of health. The most eye-opening message for me was how much rural vulnerable communities are suffering as well. When I heard my colleagues from around the country talk about their lives and healthcare situations, I was surprised to learn of the depth of the struggles they face.

The task force reinforced our previous notions that social determinants of health are critical, and we learned from programs around the U.S. that have begun to address them. I hope it will continue to be a growing wave of acknowledgement that we can't just make sure we have enough CT scanners or clinics open any given number of hours, but that we need to go deep into our communities to have an impact.

Q: Can hospitals run effective population health management programs without addressing social determinants of health?

BO: Absolutely not. That's a great question, and I think it's a question that should be a guiding principle if you aim to implement any form of population health management. I look at [population health] as a custodial responsibility for the people in our communities. It's not just about the services that go on in hospitals and clinics. If that's all you focus on, you miss opportunities to be successful in population health.

To have a custodial responsibility for a community means you have to talk to people about lifestyle choices. It's pretty intrusive to tell people how to eat and how often to exercise, but it is necessary. We can sit back and say we're a great hospital with terrific clinical services, and making these things available equals population health. Just focusing on optimizing care inside the hospital can no longer be our mission.

Q: What steps must all hospitals begin to take to address the non-medical factors that influence patients' health?

BO: If you're going to address population health, you have to look at the social determinants. Then you must look and think, if you're a hospital, what tools do you have at your disposal to make a difference? For us, we're a big business. We are going to use our business to create programs to address social determinants. For example, there is turnover every year. We can set aside a certain number of jobs for people in vulnerable communities. If we're buying millions of dollars worth of widgets, we think of how we can buy from minority-owned businesses in the community. How can we offer members of the community nutrition counseling in our building, as well as churches and supermarkets? I believe the way to succeed in population health is to take this anchor we call a healthcare system and change our course of business to address social determinants and create programs around them.


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