3 Community-Based Strategies Health Systems Can Implement Right Now

CEO Barry Ostrowsky shares how RWJBarnabas Health strives to make an impact on the communities it serves beyond traditional care.

Health systems are increasingly ramping up their efforts to address social determinants of health to help prevent illness and promote wellness among their patients and communities. According to a PwC Health Research Institute report, 80% of a person's health is made up of how they take care of themselves, what their environments are, and what their socioeconomic conditions may be, while clinical care is only responsible for 20% of a person's health.

Related: What to Expect in 2020: an Even Greater Focus on Social Determinants of Health

While health systems are equipped to help patients with clinical care, how do they help patients with that other 80% of their health? RWJBarnabas Health CEO Barry Ostrowsky says, "Patient responsibility is a certain commitment to take care of yourself. We'd like to try to teach that it's possible."

In fact, the West Orange, New Jersey­–based health system has designed its 2020 initiatives to focus on how it can help and invest in its communities, despite the disruption of the COVID-19 pandemic.

Ostrowsky says, "There are people who believe we're a healthcare system, [and so] we ought to pay attention to healthcare services, and not necessarily get involved in that kind of social programming. I … feel strongly that that's not the right approach, which is why we're doing what we're doing."

Ostrowsky shares three strategic initiatives with HealthLeaders that RWJBarnabas Health has implemented to support and work within the health system's communities and that other health systems could consider doing in theirs.

The RWJBarnabas Health system has 11 acute care hospitals that serve five million people. In 2018, the organization launched a partnership with Rutgers University, making it the state's largest academic health system in New Jersey.

This is part two of a two-part interview series. Part one focused on the strategies the health system implemented during the coronavirus outbreak, what the New Jersey hospitals looked like during the patient surge, and how the health system is preparing for a potential second wave.

1. Diversifying care models

The health system's first focus is on diversifying their care models from general acute care to more community-based settings, such as patients' homes.

"We've been spending a lot of time evaluating how we [can] bring into the system a series of non-general acute care venues and programs, a variety of therapies, as well as evaluating how we become more effective in delivering care in the home.  As we were doing that, along comes COVID, and before you know it, our medical group is conducting 10,000 plus telehealth encounters a week, most of which, of course, are going into the home," Ostrowsky says.

He continues, "The initiative of diversifying into the community-based healthcare delivery model will again be pursued in earnest, and probably at an accelerated pace, because I think folks will be reticent to come back to hospitals, at least initially, [and] will want to see more non-hospital venues, receive more care in their homes and over a variety of devices that are based digitally."

Related: Geisinger's Karen Murphy Stimulated Innovation by Focusing on Fundamentally Different Approaches to Healthcare

2. Investing in social impact

The second initiative focuses on social impact and community investment.

"One of the unfortunate results of the COVID pandemic is the definition of vulnerable community has changed. I think many people who would never have considered themselves vulnerable find themselves sadly without employment, or without their business, or having someone in their household not be able to provide sufficient resources for the family. And now they need to rely on social programs and there are, unfortunately, very few social programs available," Ostrowsky says.

He continues, "The state is wrestling with its own fiscal crisis of incredible proportions, and so its ability to create meaningful, durable, long-lasting safety net programs is limited. So, we need to step into that breach and address that."

The health system adopted a social impact and community strategy a few years ago to make "its communities healthier."

Two platforms enabled this strategy to come to fruition. "One platform is conventional clinical care, supported by the academic mission that was consummated with our Rutgers relationships and the research that goes along with that," Ostrowsky says. "And then the second platform had to be a robust series of social programs designed to address social determinants that we all know keep communities unhealthy and, sadly, disproportionately so, in our vulnerable communities."

Its community programs include:

• Funding and working directly with nonprofit, mission-driven organizations who are already doing work in the communities

• Offering programs that address food insecurity, such as building greenhouses, teaching food preparation, and mobilizing food delivery

• Providing housing

• Training and hiring people who have been chronically unemployed

• Investing in, and working with, local vendors to support the community's economic infrastructure

• Working with local law enforcement to make neighborhoods safer

• Establishing health worker projects in the community to enable connection with members of the vulnerable communities

"That work has continued and will continue to expand course," Ostrowsky says.

3. Partnering with the local university

"We had negotiated a couple of years ago a partnership with Rutgers University," Ostrowsky says. "Rutgers owns two medical schools and a series of other professional training colleges, and we put this partnership together in order to address three very specific goals."

The first goal is to invest in academics. "We wanted a more intimate relationship with our medical schools, not just an affiliation agreement," Ostrowsky says. The health system teaches students, residents, and fellows in their hospitals. "We are busily combining our residency programs and expanding our teaching footprint predicated on the relationship with the two Rutgers medical schools."

The second goal is to invest about a billion dollars into research. "We wanted to expand [the] research footprint, [and] attract and recruit more principal investigators, which we have begun to do."

Since the start of the pandemic, Rutgers developed a saliva-based test for detection of COVID-19, which received FDA approval for emergency use. "While that is obviously timely and critical to our recovery," Ostrowsky says, "research is something that we believe New Jersey has needed more of and, now with this partnership, we're able to make an effective investment in that."

The third goal is for RWJBarnabas Health to take over management of the university faculty practice plans. "When decisions in those faculty practice plans are counted alongside of our preexisting medical group, we'll have about the twelfth biggest medical group in the country," Ostrowsky says. "We'll be using the medical group of faculty and non-faculty to extend into our communities, in terms of program development, and providing care at every level of intensity."