Putting People First and Why That Works Best
Becky was midway through a high-risk pregnancy last year when she hit a wall. A single Keizer mom with three other children at home, Becky couldn't work and was facing eviction because the cash on hand was spent on feeding the family.
To make matters worse, Becky's car needed repair. So, she stopped driving even for doctors' appointments or shopping. Without enough family or other support, Becky was an emotional wreck. She feared for her unborn child and the threat of losing the others to foster care. Becky was succumbing to "toxic stress."
Hospitals and clinics are well organized to deal with Becky's medical problems. Care coordination and specialty delegation go back to Galenus, a physician of the Roman Empire, in 162 AD. Corporate healthcare may be bureaucratic, but its science and knowledge are robust, its care providers are hard-working and empathetic, and its point-of-care activities are optimized for physical health.
However, the corporate world employs standardization and hierarchical control to deliver value efficiently at scale. Markets convert value to increased revenue to achieve their higher business purpose. This engine creates financial prosperity, but its need for control strips away the complex social interdependency at the heart of humanity.
In its current configuration, healthcare is structurally unable to support Becky in regaining her greatest need: social stability. To do that, we need to take advantage of the unique strengths of the social environment.
Social systems are highly complex, adaptive, and self-organizing. Hierarchical control and fixed protocols are too slow and lack the necessary nuance.
The alternative is a management network of multiple human and social service agencies organized as a flat self-organizing network. Care coordination is multi-disciplinary and aligns individual goals to an overall desired outcome.
This model of multi-disciplinary coordination within multi-system networks supported California's Whole Person Care performance.
California's Whole Person Care (WPC) program is an initiative aimed at improving the coordination of health, behavioral health, and social services for Medi-Cal beneficiaries with complex needs. The program was designed to provide a more holistic and integrated approach to care for individuals who often have multiple chronic conditions, are homeless, or face other significant challenges that affect their health and well-being.
Becky is fortunate to be in a neighborhood served by such a network. While each nonprofit or agency in the network functions internally as a hierarchy, an adaptive outcome-based process adapts to the needs of each individual.
About 10 years ago, a local service provider began a pilot project called the Fostering Hope Initiative. An outside research firm looked, by zip code, at Salem and Keizer's poorest neighborhoods. They examined how poverty and toxic stress are connected and how even modest network support might affect the outcome.
In the three-year study, 160 families were studied, half receiving two specific benefits. The first was a community-building effort achieved through regular monthly neighborhood gatherings to socialize and share dinner. The second was the provision of a trained Community Health Worker (CHW) to work directly with families on their needs. The CHW was explicitly chosen because they lived in that neighborhood and shared the same culture and language as the people being served.
After three years, the group with even these bare-bones services showed markedly decreased toxic stress in their families. Meanwhile, the group without services continued to show increased toxic stress.
Imagine then what could be done with more services, all interconnected, sharing resources and data, with a common goal of client well-being. Findings from a five-year pilot California program – Whole Person Care (WPC) – showed that person-centric programming improves outcomes. And these were 250,000 of Medi-Cal's most difficult cases. The biggest surprise, in the study that covered rural and urban patients in 25 different counties, was that better results came attached to lower costs. Why? Because the highly coordinated, multi-agency system kept more people from needing the most expensive, emergency-related services. California has now rolled WPC into its entire statewide Medi-Cal system.
Back in the Willamette Valley, nonprofit Curandi is helping to create a similarly effective people-centric network, and the Fostering Hope Initiative (FHI) is a member. Becky, who was at her wit's end and about to be evicted, was fortunate to live in an FHI neighborhood. She called the Community Health Worker (CHW), whom she met at a neighborhood gathering the previous summer. All it took was one call to get the network working on Becky's behalf. She got back on track with prenatal care because of that sole connection. She received food boxes, rent assistance, clothing, and diapers. She got help with her transportation needs and enough money to fix her car.
Person-centric networks that adapt and respond to circumstances create more value in the social context. Becky's family is not out of the woods yet, but her toxic stress is relieved, which gives her more resiliency to manage with more confidence.