Today, I’m proud to introduce Population Health(ier), a recurring series featuring athenahealth and The Atlantic’s best storytelling on America’s population health revolution. Population health management is becoming increasing important for managing care, reducing barriers to patient access, and improving patient engagement. In this first in a series of Friday stories, we explore how a community health center in Lowell, Massachusetts has revolutionized population health for its Southeast Asian community, expanding access to quality, culturally-sensitive care and improving outcomes.
In 1985, U.S. Secretary of Health and Human Services Margaret Heckler published a detailed and damning report on health disparities in America. The document, which has become known as the Heckler Report, sought to be “the generating force for an accelerated national assault on the persistent health disparities” between white Americans and minority populations.
Since 1980, the foreign-born share of the U.S. population has climbed from six to 13.1 percent--the highest proportion in 93 years. Minority populations are up to twice as likely as whites to experience preventable hospitalizations, according to the federal Agency for Healthcare Research and Quality. They generally face higher barriers to health care, and when they receive it, they tend to receive a lower quality of care. Overall, these health disparities have been estimated to cost the health care system $230 billion annually.
This year, on the 30th anniversary of the Heckler Report, the assault on health disparities remains a work in progress. Despite decades of work, the Centers for Disease Control and Prevention reports that not nearly enough progress had been made to reduce barriers to health equality. The Affordable Care Act has been credited with tackling one of the biggest causes of disparity for immigrants: lack of insurance. But insurance does not ensure access to care. Patients’ culturally-based preconceptions can complicate the traditional delivery of U.S. health care. Closing the gap in access, healthcare experts say, depends on the cultural competence of the nation’s health care providers.
Lowell Community Health Center (LCHC) is one notable organization which has implemented culturally-sensitive population health initiatives to close gaps in care.
In Lowell, Massachusetts, where one in four are foreign born, the LCHC has become a model for treating America’s growing immigrant communities. In 2000, it established the Metta Health Center, which specializes in treating the city’s large Southeast Asian population using Eastern approaches such as meditation and acupuncture as well as traditional health-care techniques.
What set LCHC’s providers apart from the outset was the recognition that before they could adapt treatment to meet their patients’ diverse needs, they had to bring them in to find out what those needs actually were.
When Dorcas Grigg-Saito, CEO of the Lowell Community Health Center, reached out to leaders in the Cambodian community—Lowell’s biggest immigrant population—she discovered that transportation challenges, language issues, and concerns about the cost of care were limiting the community’s access to care. She also learned that victims of torture under the Khmer Rouge often distrusted anyone who looked like a government official, which included doctors dressed in ties and white lab coats.
To discover such cultural idiosyncrasies within the many communities of Lowell, Grigg-Saito now employs a team of 40 community health workers, many of whom hail from the same countries and live in the same neighborhoods as their patient populations. Within the first three years, the center’s outreach outpaced expectations, recruiting 10,000 patients—a milestone they only expected to hit in the program’s fifth year.
Now, these health workers reach more than 13,000 people out in the community each year, 10 and 20 percent of whom become patients. More immigrants from the community are seeking out its services, and health disparities are shrinking.
Lowell is beginning to find solutions to the challenges the Heckler Report first identified. At LCHC, the doctors no longer wear ties or white lab coats, and much of the staff speaks Laotian and Khmer. In a blending of eastern and western health traditions, the Metta Health Center offers acupuncture, massage, and meditation. health care system that has been crafted specifically around their needs.
Health disparities are shrinking, too. Since Metta’s founding, culturally competent approaches taken by the clinic have helped cut infection rates of hepatitis B in Cambodians by 50 percent and morbidity rates by 30 percent.
Lowell Community Health Center is on the frontlines of America’s health care revolution, modeling how to approach population health in a nation that suffers from unequal access to care. Good medical care alone will not close the health gap between America’s immigrants and minorities and the rest of the country. Make a seamless transition to population health with athenahealth’s Population Health Service in order to boost community health, as well as your bottom line.
Tune next week to read about how coming to America can have a negative effect on your health.
To experience an interactive feature along with access to the full Population Healthier content series, visit The Atlantic.