Initiated in 1995, Live Well Omaha (LWO) is a community-led collaborative created out of a shared concern that no one organization in the community has the capacity to solve health disparity issues alone. With a focus on healthy eating and active living, and an interest in obesity prevention, LWO has more than 40 active partners from a variety of sectors—public/private organizations, nonprofit, businesses, educators, health systems, and insurance companies. As a result of LWO’s work, childhood obesity rates have been held constant in the Omaha community (from 2008 to 2012); 30 municipal bike-sharing stations have been created; the employer community has embraced healthy vending; and more than $7 million of investment funding has been brought into the Omaha metro area. LWO is funded by the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention Communities Putting Prevention to Work and Community Transformation Grants. To read more about this innovative program, see this brief summary [link].
Issue Category: Public Health Preparedness
Health Leads
Health Leads, operated by lay resource specialists and college student volunteers, is a collaborative comprised of partner hospitals, health systems, community health centers, and Federally Qualified Health Centers (FQHCs) working together to integrate basic resources such as access to food, heat, and other necessities into health care delivery. Operating via clinical settings since 1996, this initiative enables providers to prescribe solutions to patients helping them manage their disease and lives. The impact of Health Leads is two-fold. The program expands clinics’ capacity to secure nonmedical resources for patients— in 2013, 92 percent of patients identified that Health Leads helped them secure at least one resource they needed to be healthy. Additionally, Health Leads is producing a pipeline of new leaders—in 2013, nearly 70 percent of Health Leads graduates entered jobs or graduate study in the fields of health or poverty. Health Leads sustainability model utilizes earned revenue, national and local philanthropy, and in-kind contributions from volunteers and health care partners to fund its operation. To read more about this innovative program, see this brief summary [link].
District of Columbia Healthy Communities Collaborative
DC Healthy Communities Collaborative—a collaborative of community health leaders and organizations—formed in 2012 to assess and address the community health needs in the Washington, D.C. area. The Collaborative works in four key areas identified as community health needs in the D.C. area: asthma, obesity, sexual health, and substance abuse/mental health. To date, the Collaborative has conducted a community health assessment identifying health needs within the D.C. area and produced a community health improvement plan with strategies to address the aforementioned health needs. D.C. Healthy Communities Collaborative is funded by member contributions. To read more about this innovative program, see this brief summary [link].
Dignity Health’s Community Health Investments
For more than 20 years, Dignity Health, a health care provider in multiple states, has been investing in the health of the communities it serves through community benefit programs and community economic initiatives, including grants and low-interest loans to nonprofits addressing community needs. Investments are targeted to populations with disproportionate unmet health needs as identified through the community health needs assessment and a Community Need Index developed by Dignity Health. Since 1990, Dignity Health has awarded more than $51 million in areas such as prevention, HIV/AIDS services, behavioral health services, and improving access to care. The Dignity Health Community Investment Program has had a total loan volume of $143 million, benefiting the community-based health programs of California, Nevada, and Arizona including: providing affordable housing for seniors; access to shelters for the homeless discharged from community hospitals; and healthy food projects. To read more about this innovative program, see this brief summary [link].
Dallas Information Exchange Portal
The Dallas Information Exchange Portal (IEP) is an electronic platform which enables health care providers, community based organizations, and social service agencies to share medical and social information via a secure network. Through patient-authorized, secure two-way exchange of information, IEP is improving care transitions and increasing coordination of care around both clinical and social issues like homelessness, hunger, and substance abuse. The ultimate goal of the program is not only to improve clinical outcomes and measures, but also generate significant cost savings to health systems. The initiative began in 2014 with a $12 million grant from the W.W. Caruth, Jr. Foundation at Communities Foundation of Texas. To read more about this innovative program, see this brief summary [link].
Cultivating Health for Success
Cultivating Health for Success (CHS) established in 2010, focuses on the inclusion of safe, affordable, and supportive housing to reduce unplanned care, improve adherence to recommended treatment, and improve health care cost and outcomes as well as quality of life for participants in greater Pittsburgh. CHS serves adults with one or more chronic illnesses and those with a history of at least one year of above average use of unplanned care, such as crisis services, Emergency Department visits, and the homeless. To deliver services, CHS partners with the Allegheny County Department of Human Services, Metro Family Practice, Community Human Services, UPMC for You, and the Community Care Behavioral Health Organization. Since CHS’s inception, per-member per-month (PMPM) medical costs have decreased 11.5 percent, the average PMPM for unplanned care has decreased by 19.2 percent, and the average prescription PMPM increased by 5.2 percent for participants with a meaningful tenure in the program. CHS is funded by UMPC for You contributions. To read more about this innovative program, see this brief summary [link].
Common Table Health Alliance: Backbone for the Healthy Shelby Partnership
The Common Table Health Alliance is a regional health improvement collaborative and an Aligning Forces for Quality Community. In 2011, the Shelby County Mayor, Memphis City Mayor, and the four major health systems engaged the Common Table Health Alliance as the backbone organization for the Healthy Shelby Partnership, which is one of the key pillars of Memphis Fast Forward, a broad-based collective impact initiative. Healthy Shelby connects social service agencies with the health care system to jointly address the social determinants of health. Common Table Health Alliance has implemented evidence-based and best practices, used social media, employed education programs, coordinated partner engagement, and is tracking 12 measures. Successful programs include a safe sleep campaign and a community hypertension registry. The goal is to improve the health rankings of Memphis and Shelby County. Healthy Shelby has received core funding from the Baptist Memorial Health Care, Methodist LeBonheur Healthcare, Region One Health and Saint Francis Hospital, city and county governments, and grants from the United Way and Medtronic. To read more about this innovative program, see this brief summary [link].
Changing the Narrative About What Creates Health—Essential Steps in Improving Population Health in Minnesota
The goal of Changing the Narrative about What Creates Health— Essential Steps in Improving Population Health is to bring about critical change to effectively address the social determinants of health and achieve health equity. Launched in 2011 by the Minnesota Health Department, this initiative shifts the responsibility for health to a community level to address the conditions in which all people can be healthy through policy, systems, and environmental changes. Key strategies include: the creation of a Healthy Minnesota 2020 framework that engages partners in all sectors; community engagement via the Healthy Minnesota Partnership, establishment of cabinet-level committee on Health in All Policies; a State Health Improvement Program that outlines policy, systems, and environmental changes; and creation of Accountable Communities for Health. By focusing the narrative on what creates health (beyond the health system), community agencies and groups have become involved in health policies contributing to policy changes including: anti-bullying law; minimum wage increase; smoke-free campuses and apartments; and complete street ordinances. Minnesota has also shown decreasing rates of childhood obesity and youth tobacco use, and increasing rates of breastfeeding. This initiative is funded by State Health Department grants. To read more about this innovative program, see this brief summary [link].
Campaign to Make Delaware’s Children the Healthiest in the Nation
Since 2006, Nemours, an integrated pediatric health system, has worked to address childhood (ages 2–17) overweight and obesity in Delaware with multisector partners including: the Governor’s Office; Cabinet secretaries and other government officials; pediatric providers; child care centers; schools; principals and superintendents; and other community-based organizations. Activities include systems-level and practice interventions, such as working with state-level partners to promote healthy eating and physical activity through child care licensing, as well as creating a learning collaborative to facilitate policy and practice change. Preliminary results show a flattening of the overweight and obesity curve for Delaware children between 2006 and 2008. This successful initiative is funded by a number of sources including: Nemours Health and Preventive Services; the Robert Wood Johnson Foundation; U.S. Department of Education; U.S. Department of Agriculture; Centers for Disease Control and Prevention; General Mills Foundation; and American Heart Association. To read more about this innovative program, see this brief summary [link].
Boston Children’s Hospital Community Asthma Initiative
The Community Asthma Initiative (CAI), an initiative of Boston Children’s Hospital, began addressing health disparities in Boston neighborhoods impacted by asthma in 2005. CAI provides an enhanced model of care which includes asthma education and home visits for families with children ages 2–18 living in the Greater Boston area who were previously treated in the Emergency Department (ED) or hospitalized as a result of asthma. CAI works with partners and coalitions to address asthma health disparities by implementing changes in policies at the local and state levels. As of June 2014, case management had been provided to 1,329 patients with significant outcomes including: a 57 percent reduction in the number of children with ED visits; a 79 percent reduction in hospitalizations; a 43 percent reduction in missed school days; and 43 percent reduction in missed work days for parents. CAI is supported in part by grants, several foundations, philanthropy, Centers for Disease Control REACH US Program, American Academy of Pediatrics, the Office of Community Health at Boston’s Children’s Hospital and others. To read more about this innovative program, see this brief summary [link].