Innovation ’19: SDOH

At Johns Hopkins, payroll additions are doing duty as SDOH intervention

The storied hospital in Baltimore has hired 70 community health workers and peer recovery specialists from the city’s disadvantaged neighborhoods.

Timothy Kelley
Senior Contributing Editor

The taxicab had to stop at the light—it was the law. You could hardly blame the driver, or Johns Hopkins Hospital’s Emergency Department. But the drug-addicted passenger, who was being taken to rehab in the cab, hopped out and went off to score more drugs. In effect, it was a costly fare for all of us. “He was back in the ED within hours,” says Nicki McCann, the hospital’s chief of staff.

Today that addict who once made almost daily ED visits is in a drug treatment program, thanks to a venture by which Hopkins addresses the social determinants of health in a novel way. It’s the Baltimore Population Health Workforce Collaborative, a joint project with eight other city hospitals that hires people from nearby low-income sections of the city.

“We’re trying to take a broad view of population health, recognizing that it’s not just people’s medical issues that contribute to their health situation, but their socioeconomic status as well—their lack of opportunity for meaningful employment, for instance,” says McCann. Baltimore used to bristle with manufacturing jobs one could get without much education, she points out. Today those jobs are gone.

The idea for the Population Workforce Collaborative was born after the sometimes-violent Baltimore street protests of 2015 that erupted when Freddie Gray, a 25-year-old African-American resident, sustained fatal wounds while in police custody. “As one of the largest employers in the city, we in the Johns Hopkins Health System felt it was our responsibility to try to respond and create opportunity,” says McCann.

Approved by regulators in concept in 2015 and in specific structure in 2016, the jobs program was launched in late 2017. It directly touches only a comparative handful of lives, but does so with a double benefit: It provides an individual and his or her family with the income from a stable job and the possibility of advancement, while addressing public health problems in the poor neighborhoods of Baltimore.

Employees are hired as community health workers or as peer recovery specialists. Peer recovery specialists (like the one who finally convinced that costly-to-care-for cab passenger to get help) connect people with addictions to treatment and other resources. The specialists are recovered addicts who know what it’s like to battle drugs. Community health workers visit residents’ homes and help them surmount whatever obstacles are getting in the way of health—helping them to achieve better control of diabetes, for example, or connecting them with various assistance programs.

Community health workers and peer recovery specialists now account for roughly 70 employees at Johns Hopkins Hospital and 200 when all of the city’s hospitals are included. They start at $15 an hour, with the same benefits package as other hospital employees. Having been on the job a little more than a year now, they have so far shown a remarkable retention rate of 92%, according to McCann. As for other evidence of this program’s success, she says it’s mostly anecdotal at this point, but reporting requirements assure that ultimately there will be hard data.

Meanwhile, she believes two essential ingredients have given the collaborative a fighting chance. One is approval by the state’s Health Services Cost Review Commission to use hospital rates to fund the initiative (Maryland has a unique “all-payer” system). The second ingredient is the collaborative’s two partner organizations.

One of those partners is Turnaround Tuesday, which prepares community residents—including those with prison stints or long periods of unemployment that might scare off employers—to master life and job skills. The other is the Baltimore Alliance for Careers in Health Care, which offers specific training for health care positions. The two groups help prepare prospective employees, but the human resources departments at the hospitals make the actual hiring decisions. Significantly, Turnaround Tuesday continues coaching sessions with program participants for two years into their new employment.

McCann believes the Population Health Workforce Collaborative is an idea that could be replicated elsewhere, especially at hospitals in urban centers, which often double as the community’s biggest employer and economic engine. “Be creative about your hiring,” she advises. Other ideas: Make sure employment offers opportunities for advancement, consider offering financial support for proven employees who wish to return to school (a Hopkins program allows workers who become full-time students to continue to draw their full-time wage while their work hours have been reduced to part time), and consider collaborating with other local employers. Partly to assure good community relations and avoid any taint of condescension in dealing with disadvantaged communities, she says it’s important to identify a community-based partner organization like Turnaround Tuesday.

“You can’t do this alone,” she warns.

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