‘Bureaucratic ninjas’ slice red-tape to battle health disparities

Aug 7 2017

When a receptionist hands out a form to fill out at a doctor’s office, the questions are usually about medical issues: What’s the visit for? Are you allergic to anything? Up to date on vaccines?

But some health organizations are now asking much more general questions: Do you have trouble paying your bills? Do you feel safe at home? Do you have enough to eat? Research shows these factors can be as important to health as exercise habits or whether you get enough sleep.

Research has begun to show that a person’s ZIP code can be as important to her health as her genetic code.

That’s why Shannon McGrath was asked to fill in a “life situation form” this spring when she turned up for her first obstetrics appointment at Kaiser Permanente in Portland, Ore. She was 36 weeks pregnant. (Kaiser Health News is not affiliated with Kaiser Permanente.)

“When I got pregnant I was homeless,” she said. “I didn’t have a lot of structure. And so it was hard to make an appointment. I had struggles with child care for my other kids; transportation; financial struggles.”

The form asked about her rent, her debts, her child care situation and other social factors. Based on her answers, Kaiser Permanente assigned her a “patient navigator.”

“She automatically set up my next few appointments and then set up the rides for them, because that was my No. 1 struggle,” McGrath said. “She assured me that child care wouldn’t be an issue and that it would be OK if they came. So I brought the kids and everything was easy, just like she said it would be.”

Her navigator helped McGrath get in touch with local nonprofits who helped her with rent, a phone and essentials for the baby — such as diapers and bottles — all in the hope that making her life easier might keep her healthier and, in turn, keep KP’s medical costs lower.

McGrath said her patient navigator, Angelette Hamilton, was a bureaucratic ninja, removing paperwork obstacles that kept her from taking care of herself and her family.

Patient navigators have been around for a while. What’s new is the form McGrath filled out and how hospitals are using the socioeconomic data the forms glean to serve patients. The details now go into a patient’s file, which means providers such as Dr. Sarah Lambert have more information at a glance.

“I find it incredibly helpful because it can be very hard to find out,” said Lambert, who is McGrath’s OB-GYN and works at Kaiser Permanente Northwest. “Having it coded right there — we have this problem list that jumps up — really can give you a much better understanding as to what the patient’s going through.”

Federal officials introduced new medical codes for the social determinants of health a few years ago, said Cara James, director of the Office of Minority Health at the Centers for Medicare & Medicaid Services.

“More providers are beginning to recognize the impact that the social determinants have on their patients,” she said.

Nicole Friedman, a regional manager at Kaiser Permanente Northwest, agreed. But she goes one step further.

She hopes giving doctors more information about the home life of each patient will push health care in a new direction — away from more high-priced treatments and toward providing the basics that protect a person’s health.

“My personal belief is that putting more money into health care is a moral sin,” she said. “We need to take money out of health care and put it into other social inputs, like housing and food and transportation.”

Linking health organizations like KP with nonprofit social services such as the Oregon Food Bank will help governments and medical providers see where their money can make the biggest difference, Friedman said.

For example, spending more on affordable housing for homeless people can also have health benefits — in turn, saving the government money down the line.

Friedman said that when KP started addressing people’s social needs, one study found a 40 percent reduction in emergency room utilization.

McGrath was initially skeptical when doctors offered to help her with things like rent and transportation.

“I didn’t want someone to see my situation and have it raise alarms,” she said.

But ultimately she was glad to have shared that information.

“I’m able to look at life and not feel overwhelmed or burdened,” she said, “or like I’ve got the whole world on my shoulders.”

This story is part of a partnership that includes Oregon Public Broadcasting, NPR and Kaiser Health News.