"Full participation of every patient in finding and using safe, decent health care is vital to the success of the health
care enterprise in improving the health of individuals and the population."
- Center for Advancing Health
I don't think that anyone would necessarily say that an engaged patient-base is a bad thing. However, when it's time to allocate resources and invest in a means, patient-engagement processes often have to compete with the other priority costs. How can having a 15-20 minute conversation with one patient measure up with diagnosing, treating, or providing preventative medicine to another, maybe more than one? It's a tough argument logistically and financially. When and how will you see the return? Like other models of prevention, the earlier in life it happens the greater financial and human capital return you see, but ofcourse, this does not happen over time.
I would like to make a case, though, that the integration of a bilateral system of designing and delivering care will decrease unnecessary expenses having to do missed appointments and follow up. This is of course on top of the expected increase the success of patient health outcomes and level of patient health literacy and decrease of emergency treatment and tertiary care that collectively would increase the overall capacity of the provider.
I also think there is an equity in this authentically engaging patients as stakeholders that doesn't often get measured in ROI calculators or the financial bottom line. While our health care system hasn't exactly been promoting systems of care that focus on those "intrinsic values", I think there are ways to show a correlation between equity, impact, and return. Ofcourse, much of this work centers around the medical home, as opposed to secondary and emergent treatment. This can be seen through the regrowth of the patient-centered medical home (NCQA) and the attempt of providers to provide team-based, whole person care that is continuous and coordinated. A concept that no doubt benefits most people, directly and indirectly, but has the greatest impact on those populations experience disparities in health and health care access. Within those populations, I'd argue that among the most vulnerable to those disparities are youth. Therefore, an equitable system of care, that is patient-centered, is integrated into the environment that young people spend a majority of their time: school.
School-based health centers (SBHC) are increasingly becoming certified as patient-centered medical homes in providing primary care to some of the most vulnerable populations of uninsured and underinsured youth. They are key components to care management entities that keep state medicaid costs down, are beginning to be integrated into accountable care organizations, and, as I see it, are positioned uniquely to excel in taking youth beyond patients, into stakeholders. SBHCs have the capacity to work with their patients to shape their environment, how they delivery care, what care is delivered, and by doing this, build the level of investment their patients have in their infrastructure.
While there is little research around patient-engagment targeted towards youth, there is tons of research (and jargon) around youth development, youth engagement, and youth empowerment. Despite being "The generation we love to dump on" Millennials are proven to be community minded multi-taskers that want to be engaged.
Models of creating "youth-adult partnerships" (Zeldin), meaning the practice of (a)the practice of multiple youth and multiple adults deliberating and acting together, (b) in a collective (democratic) fashion (c) over a sustained period of time, (d) through shared work, (e)intended to promote social justice, strengthen an organization and/or affirmatively address a community issue, have been documented as creating an outcomes-generating connectedness. Centered around age equity, authentic partnership between youth and adults produce an impact to all of the people involved and then systems that they are attached too (health care, education, government, etc.).
Models of "youth empowerment", with engrained methods of developing individual youth capacity, are focused on individual, organizational, and community change outcomes. Empowerment theory has been documented well by Marc Zimmerman and Brian Christens, and go beyond impacting individual behaviors of youth to prepare them to authentically participate in the systems that impact them the most.
Even in models of "youth organizing" (Christens), where youth come together to talk about the most pressing problems in their communities, conduct research on these problems and possible solutions, and follow through with social action to create community-level change, when implemented through a partnership between a young person and their medical home, the potential is a population level change in health disparities.
While these models are traditionally being implemented within youth-serving non profit organizations, programs and groups outside of the health care system, there are those that are finding the crossover innovation and utility of these models. In Part 3 we'll talk about what this looks like in a health care setting, (hopefully) get some highlights of an awesome organization doing this in Michigan and talk about the cost-effectiveness of this work.
- Center for Advancing Health
I don't think that anyone would necessarily say that an engaged patient-base is a bad thing. However, when it's time to allocate resources and invest in a means, patient-engagement processes often have to compete with the other priority costs. How can having a 15-20 minute conversation with one patient measure up with diagnosing, treating, or providing preventative medicine to another, maybe more than one? It's a tough argument logistically and financially. When and how will you see the return? Like other models of prevention, the earlier in life it happens the greater financial and human capital return you see, but ofcourse, this does not happen over time.
I would like to make a case, though, that the integration of a bilateral system of designing and delivering care will decrease unnecessary expenses having to do missed appointments and follow up. This is of course on top of the expected increase the success of patient health outcomes and level of patient health literacy and decrease of emergency treatment and tertiary care that collectively would increase the overall capacity of the provider.
I also think there is an equity in this authentically engaging patients as stakeholders that doesn't often get measured in ROI calculators or the financial bottom line. While our health care system hasn't exactly been promoting systems of care that focus on those "intrinsic values", I think there are ways to show a correlation between equity, impact, and return. Ofcourse, much of this work centers around the medical home, as opposed to secondary and emergent treatment. This can be seen through the regrowth of the patient-centered medical home (NCQA) and the attempt of providers to provide team-based, whole person care that is continuous and coordinated. A concept that no doubt benefits most people, directly and indirectly, but has the greatest impact on those populations experience disparities in health and health care access. Within those populations, I'd argue that among the most vulnerable to those disparities are youth. Therefore, an equitable system of care, that is patient-centered, is integrated into the environment that young people spend a majority of their time: school.
School-based health centers (SBHC) are increasingly becoming certified as patient-centered medical homes in providing primary care to some of the most vulnerable populations of uninsured and underinsured youth. They are key components to care management entities that keep state medicaid costs down, are beginning to be integrated into accountable care organizations, and, as I see it, are positioned uniquely to excel in taking youth beyond patients, into stakeholders. SBHCs have the capacity to work with their patients to shape their environment, how they delivery care, what care is delivered, and by doing this, build the level of investment their patients have in their infrastructure.
While there is little research around patient-engagment targeted towards youth, there is tons of research (and jargon) around youth development, youth engagement, and youth empowerment. Despite being "The generation we love to dump on" Millennials are proven to be community minded multi-taskers that want to be engaged.
Models of creating "youth-adult partnerships" (Zeldin), meaning the practice of (a)the practice of multiple youth and multiple adults deliberating and acting together, (b) in a collective (democratic) fashion (c) over a sustained period of time, (d) through shared work, (e)intended to promote social justice, strengthen an organization and/or affirmatively address a community issue, have been documented as creating an outcomes-generating connectedness. Centered around age equity, authentic partnership between youth and adults produce an impact to all of the people involved and then systems that they are attached too (health care, education, government, etc.).
Models of "youth empowerment", with engrained methods of developing individual youth capacity, are focused on individual, organizational, and community change outcomes. Empowerment theory has been documented well by Marc Zimmerman and Brian Christens, and go beyond impacting individual behaviors of youth to prepare them to authentically participate in the systems that impact them the most.
Even in models of "youth organizing" (Christens), where youth come together to talk about the most pressing problems in their communities, conduct research on these problems and possible solutions, and follow through with social action to create community-level change, when implemented through a partnership between a young person and their medical home, the potential is a population level change in health disparities.
While these models are traditionally being implemented within youth-serving non profit organizations, programs and groups outside of the health care system, there are those that are finding the crossover innovation and utility of these models. In Part 3 we'll talk about what this looks like in a health care setting, (hopefully) get some highlights of an awesome organization doing this in Michigan and talk about the cost-effectiveness of this work.
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