Ordinary Citizens Fill Gaps in Health Care

U.S. hospitals borrow idea from South Africa

Destini Belton isn’t a doctor or a nurse. She’s a trained health coach, and as a trusted neighbor in Harlem, she goes where clinics and hospitals can’t—into patients’ homes to understand the mundane but vital details of their lives.

Belton’s work follows an example from half a world away, according to a report from Kaiser Health News. A nonprofit group called Mamelani Projects brings health care into neighborhoods in Cape Town, South Africa, by employing trusted community leaders. There are surprising similarities between South Africa and the U.S.: a shortage of doctors in poor neighborhoods; widespread distrust of once-segregated hospitals; concentrated and crippling poverty; and a growing recognition that models of care that go beyond brick-and-mortar clinics are needed.

Belton is one of a small team of community health workers trained by Manmeet Kaur to help patients in New York City. Kaur trained with the Mamelani Projects in the townships of Cape Town. The organization she founded, City Health Works, contracts directly with primary care providers, such as the Mount Sinai Health System, to better manage their most difficult patients.

In the U.S., the need for health coaches is spurred in part by the Patient Protection and Affordable Care Act and by major changes in how hospitals are paid. Private and public insurers are testing so-called bundled payments and other strategies that reward value instead of volume, and there are strong financial incentives to steady the lives of people with needs, even when those needs seem to have nothing to do with health care.

Coaches use electronic health records to inform doctors about developments in the field, such as whether patients are taking their medications or experiencing changes in their mental health.

But Kaur goes home each night to one of her biggest skeptics. Her husband, Dr. Prabhjot Singh, heads the department of health-system design at Mount Sinai. He’s weighing whether there’s enough evidence that her program works and should be integrated into Mount Sinai’s core business.

“Every time somebody sees one of these beautiful, well-designed, kind of custom engagement tools, I think the thought that comes up a lot with my colleagues, and frankly my own, is: How do you do this for 40,000 people––50,000 people––at the scale of the Mount Sinai Health System?” Singh said.

But there are early signs the program is working: Patients with health coaches cost $600 a month less in medical care than a control group, indicating that coaches prevented expensive medical emergencies. For half the patients, coaches alerted doctors about patients’ urgent needs.

Source: Kaiser Health Care; October 20, 2016.