More Than Medicine: Community Care for Advancing Health

00:00:00:02 - 00:00:19:08
Tom Haederle
Welcome to Advancing Health. Achieving good health is a balance of many factors beyond clinical care. In this Leadership Dialog podcast, we learn how Denver Health takes a holistic approach to wellness that even includes providing housing options for those who need it.

00:00:19:10 - 00:00:38:06
Marc Boom, M.D.
Greetings and thank you everyone for joining us today. I'm Marc Boom. I'm the president and CEO of Houston Methodist, and I'm the current board chair of the American Hospital Association. As we continue these discussions, we're going to focus today's conversation on the importance of community health and the innovative, impactful work that often takes place outside of the four walls of a hospital.

00:00:38:07 - 00:01:01:18
Marc Boom, M.D.
Because as hospitals and health systems, we work to improve the overall health and well-being of those we serve. And we know that clinical care accounts for only about 20% of an individual's health status, meaning that achieving good health involves so many factors, from housing and education to employment and access to nutritious food. So, to truly improve health, we know that we must care for our patients very holistically.

00:01:01:19 - 00:01:22:22
Marc Boom, M.D.
We need to address all factors that affect their health and well-being. So today, I'm pleased to be joined by Donna Lynne, the CEO of Denver Health. And in a moment, I'll ask her to tell us a bit about herself. But I want to share briefly that Denver Health is Colorado's primary safety net health system, and is very well known for providing a broad range of health services across the Denver community.

00:01:22:24 - 00:01:45:03
Marc Boom, M.D.
Denver Health is an academic medical center that also serves the community by providing care at ten family health and primary care centers and 19 school based health centers. So, without further ado, let's jump into our conversation. So, Donna, our viewers always like to know a little bit about our guests before we get started. So please tell us about your pathway and how it has influenced the work you're now championing at Denver Health.

00:01:45:09 - 00:02:08:00
Donna Lynne
It's great to see you again, and I'm happy to talk to you and to the viewers. I often say that careers only make sense looking backwards, and I'm certainly one of those people. So I'd say I have a non-linear career. I started off my first 20 years in the public sector, but that connection with the community really resonates with me in terms of the work that I did.

00:02:08:00 - 00:02:29:25
Donna Lynne
So I worked in New York City for four mayors and focused on a lot of issues. Whether it was the budget, it was human resources, and certainly as part of human resources, healthcare and trying to think about how do you make healthcare more affordable for some of those public servants? I spent time in two different health plan organizations.

00:02:29:26 - 00:02:52:27
Donna Lynne
I was the lieutenant governor for the state of Colorado and worked also at Columbia University Medical Center. So it's a 50 year career, so there's lots of pieces to it. And as you said, I'm now happily at Denver Health. But all of those organizations were large. They were complex and, you know, not real verticals, as I say, that were just focused on one thing.

00:02:52:27 - 00:03:20:09
Donna Lynne
And building that community is really important, and certainly here at Denver Health. We have a hospital, but we also have a lot of other arms to us. We run the ambulance system, for example, for the city and County of Denver. We provide health care in the jails. We're a $1.6 billion organization and about 9,000 employees. The majority of our patients actually are seen in those clinics that you describe.

00:03:20:09 - 00:03:33:18
Donna Lynne
The ten community clinics, soon to be 11, and our 19 public schools. And we touched so many of those social determinants of health and I'm sure we'll talk about as we go forward.

00:03:33:20 - 00:04:00:09
Marc Boom, M.D.
Well, fantastic. And four mayors, I bet you that I taught you to be nimble because I'm sure priorities moved and changed on you during that time. So I know that you're very intentional and strategic. So talk a little bit about how you think strategically about thinking in terms of the community as a whole. And you alluded to it, but how is that involved addressing those social drivers of health as core pillars in your health system?

00:04:00:12 - 00:04:28:15
Donna Lynne
Sure. And thank you for that. So I think first to start with a profile of what our patients look like. 47% of our patients are on Medicaid. About 15% are uninsured. And so that leaves a minority of those who might be on traditional commercial insurance, working. And hopefully, even though some of the folks who certainly are working in lower wage jobs might have some of the complicated issues that we deal with.

00:04:28:15 - 00:04:58:02
Donna Lynne
But the majority of our patients oftentimes have housing insecurity, food insecurity, challenges around transportation. And so we have to focus very much on what else do they bring to the table. I like to say - although our chair of orthopedics doesn't like it when I say this - anybody can fix a broken arm. But we fix a lot of other broken things, including some mental health and substance use issues.

00:04:58:02 - 00:05:33:25
Donna Lynne
About a third of our patients have mental health and substance use as part of their condition. And so it's not just fixing that broken arm, it is dealing with much more long term chronic conditions that are sometimes influenced by things, you know, outside of our four walls. So we do social needs screening for all of our patients. We routinely look at their income, household size, and also even in a place like dental, which we didn't talk about, we provide dental care in those high schools and in our community clinics.

00:05:33:27 - 00:05:59:08
Donna Lynne
Even our dentists are trained to ask questions about patients mental health. So it's so diverse to do both the economic and social screening that we not only provide a lot of those services ourselves, but we have a lot of partners in the community that we rely on, whether it's Food Bank for the Rockies or housing organizations that very much support what we do.

00:05:59:08 - 00:06:21:10
Donna Lynne
And then the last thing I'd add in this sphere is about two and a half years ago, we started providing housing for our patients because we recognized that many of them have no place to go once we're ready for discharge in the hospital. They don't have a guardian, they don't have family members. They were living on the street, or maybe they were just housing insecure.

00:06:21:12 - 00:06:33:13
Donna Lynne
So we now have 34 apartments that we provide to our patients. It avoids long stays, it avoids repeat admissions. And quite frankly, it's the right thing to do.

00:06:33:16 - 00:06:45:13
Marc Boom, M.D.
So 34 different apartments themselves. How do you figure out the prioritization of that? How do you how do you sort out who goes there and how long do people typically stay? Is it a bridge to others? How do you use that?

00:06:45:15 - 00:07:12:27
Donna Lynne
Yeah, that's a great question. So there's two types of housing that we provide. One is called recuperative care. And so those are patients for whom maybe wound care is still necessary. But that's not paid in our current healthcare system as an inpatient service. So we will discharge patients to a housing complex that we work on with the Colorado Coalition for the Homeless.

00:07:12:27 - 00:07:43:04
Donna Lynne
And they have a clinic inside that housing complex. So they're able to provide that kind of continuing care. And their average length of stay is only 2 to 3 days, so quick. But it discharges them. And as you know, we get paid on a DRG and we're done. And it provides them with a little bit of shelter. And that organization, the Colorado Coalition for the Homeless, also works with them on perhaps a move to something that is longer term.

00:07:43:04 - 00:08:12:10
Donna Lynne
So that's 20 of our 34 apartments. We also have 14 apartments that are much more for people who don't need recuperative care, but we know have no place to go. And perhaps more highly utilized in the cold months here in Colorado. And those patients can stay up to six months and they get moved into a housing authority, the Denver Housing Authority Service, which again, is an important partner for Denver Health.

00:08:12:10 - 00:08:35:15
Donna Lynne
And we both work during that time that they're in the apartment on there, perhaps their behavioral health needs and on certainly some more permanent type of housing. So it's really a great program. Our mayor loves it because we do have a homeless problem in the city, although 14 apartments isn't going to put much of a dent in it.

00:08:35:16 - 00:09:02:12
Donna Lynne
It is a way for us to collaborate both with the mayor and with the housing authority, and to provide some social support to those patients. They don't need an inpatient admission into our psychiatric unit, and they might not be willing or able to pursue outpatient care in one of our clinics. So we bring some of those services directly to them while we're working on longer term housing.

00:09:02:14 - 00:09:09:18
Marc Boom, M.D.
What a great program. Now, y'all recently won the AHA Nova Award. Tell us a little bit more about that.

00:09:09:19 - 00:09:38:01
Donna Lynne
Sure. Thank you. And it was such an honor to get that award, which is very competitive. And in fact, it was for this program that we call Hope, which is housing, outreach, partnership and engagements. And last year we saw at Denver Health, 14,000 patients who were housing insecure or experiencing homelessness. And, you know, in the past, we would sometimes hold on to them in our inpatient units, which was unnecessary.

00:09:38:01 - 00:10:06:00
Donna Lynne
And as I said, we weren't seeing reimbursement for that and we weren't getting paid. And that increased our uncompensated care. And while as a safety net, we take all patients regardless of their ability to pay, we still at the end of the day, we have to make a little bit of margin to be able to continue. So having a place for patients to transition, to safely recover is critically important to improving our length of stay,

00:10:06:00 - 00:10:34:12
Donna Lynne
and just from a humane perspective. So our hospitalists, who really are the core of this program. Also, we're experiencing some what we call in healthcare, as you know, a little moral distress. Those 34 apartments that we have can't solve the problem. But partnerships with other housing organizations is also an important part of this program. So we're looking to sustain the program, to scale it.

00:10:34:19 - 00:10:59:16
Donna Lynne
Having the recognition from AHA is important because what I'll do is I'll go to funders and say, the American Hospital Association recognize how innovative and how essential this program is. And we're really excited because I think it gives us a great opportunity. As you know, we have some storm clouds on the horizon with HR One. And even in the impact that HR One has on our own state budget.

00:10:59:18 - 00:11:12:13
Donna Lynne
So bringing together all those other resources coupled with this recognition, I think, is going to give us an opportunity to seek additional funding from foundations and maybe even from our legislature.

00:11:12:20 - 00:11:29:24
Marc Boom, M.D.
I love the fact that the award, hopefully, is a little bit of a catalyst even to grow the program further and help more humans. So, you know, that's a great example of innovation. You all are really a designated safety net is what you do. And we have, of course, some wonderful institution in Houston that does it.

00:11:29:24 - 00:11:45:01
Marc Boom, M.D.
But we're all safety nets, every hospital, we care for our community. So what would you be your advice to other hospital leaders about how they tackle innovation in delivering care and innovation in functioning to improve that community health?

00:11:45:03 - 00:12:07:01
Donna Lynne
Sure. And I think in addition to, as I said, it being the humane thing to do, and as you said, every hospital, I mean, we could talk a lot about rural hospitals who are the lifeblood of their communities. Any hospital, as a large employer, is providing a vital economic function in their communities. And you're absolutely right. We all take Medicaid for the most part.

00:12:07:02 - 00:12:36:10
Donna Lynne
We all struggle with how do we make this complex financial formula work? We approach this not just though from the humane perspective. We said, is there a business case that we can prove that this investment - because nobody paid for it - makes sense. And the investment is not just in the people, our hospitalists who do the work, but we pay the rent for these two facilities that are mentioned.

00:12:36:10 - 00:13:01:00
Donna Lynne
So what we started looking at was how long do homeless patients or housing insecure patients stay in the hospital? And we know that they stay, on average, about two and a half times longer than other patients. We also know that they are a source of readmissions and they're coming back. And again, some of them have Medicaid, but many of them are not insured.

00:13:01:00 - 00:13:31:01
Donna Lynne
And so we thought, let's figure out how this strategy of renting apartments could decrease the length of stay, could reduce readmissions, as well as create a more moral environment for these patients. So we literally just did a business analysis. I would point out too, I know I just read in Health Affairs, Massachusetts has a housing program similar to ours, much bigger in scale, and they published an article that was very rigorous.

00:13:31:01 - 00:13:56:07
Donna Lynne
It was part of a 1115 waiver from Medicaid. But while I'm proud of what we do, we're not the only health care system doing this. I know University Hospital System in Missouri is doing a similar program. So I think, what are the economics? What challenges do we all have, and how can we make a dent in what's going on in our society?

00:13:56:07 - 00:14:10:02
Donna Lynne
As we know, homelessness is not a problem that is just restricted to certain states or certain urban areas. It's a major problem. So we did the financial analysis and we said, this really makes sense from an economic point of view.

00:14:10:09 - 00:14:26:01
Marc Boom, M.D.
And you bring up one of the things I always say to my team is, look, when others are doing similar work, go cheat off their paper because we're all we're all in it together. We're all there to help humanity, right? Last thing I want to ask you about, and you've talked about this a couple of times. Community partners in all of this work are critically important.

00:14:26:02 - 00:14:32:21
Marc Boom, M.D.
Hospitals can't do it alone. Sometimes we may be the anchor to that, but we can't do it alone. So talk a little more about the partners you're working with.

00:14:32:28 - 00:15:05:08
Donna Lynne
Absolutely. And as you said, many of us, whether it's hospitals, health care systems or some of the other community organizations, we all have the same goal. We want to improve the health of our community so that we see young people graduating from school, either moving on to higher ed or perhaps moving right into jobs. I look at our investment in the community also as a job strategy, as we're perceived of as a good employer, and one that's looking at the whole patient.

00:15:05:14 - 00:15:37:03
Donna Lynne
Our partners oftentimes provide us with patients, with employees, and so we have partnerships with a number of food bank organizations. And we actually raised money to provide 250 of our patients with food, continuous food over a nine month period. We have another organization called revision that provides food boxes to patients when they're discharged. And one thing I didn't talk about was our mobile health care.

00:15:37:03 - 00:16:01:18
Donna Lynne
And that is really important because as I said, transportation can be a challenge. We do provide some free transportation where we can through Medicaid, but we also take our mobile health units out into the community. And in some cases, those mobile health units are parked at a school, for example, where we may not have a health clinic. We don't have a health clinic in all of our Denver public schools.

00:16:01:20 - 00:16:28:19
Donna Lynne
The partnership that we have with the public school system is tremendously important. Principals refer patients to us, the superintendent of the school system and I are friends and work together. And so our vans will move around to other schools as well. I think all those social determinants of health that we've talked about beg that we use partnerships because we can't go out and buy the food ourselves.

00:16:28:19 - 00:16:52:07
Donna Lynne
And as I said, transportation to a certain extent is provided under Medicaid. But having a different kind of strategy, including a telehealth strategy, just help us get to patients where they are. And I think that's so important. We don't believe everybody should drive to one place to get health care. When we can bring it to the community, that's a much better strategy.

00:16:52:12 - 00:17:09:03
Marc Boom, M.D.
Well, you all are doing amazing work. So Donna, thank you so much for your time today. I'm sure this has been an inspiration to many people. I'm already filing away some ideas of things we need to look at and how we serve our community even better. And just really appreciate all of your insight. To all of our viewers,

00:17:09:03 - 00:17:16:02
Marc Boom, M.D.
thank you for finding the time to listen today. I'll be back next month for another Leadership Dialog conversation.

00:17:16:04 - 00:17:24:24
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.