Can we get from 'community-centered health homes' to community-centered health systems?

By DAVID FUKUZAWA

The Prevention Institute will host a May 10 interactive web forum on Community-Centered Health Homes, a concept developed and presented in a paper issued last year. It was compelling enough work that the Institute for Alternative Futures took note of it and featured it prominently in “Primary Care 2025,” a Kresge-funded report published earlier this year.

What is a Community-Centered Health Home? The Prevention Institute authors say that it:

Provides high quality health care services while also applying diagnostic and critical thinking skills to the underlying factors that shape patterns of injury and illness. By strategically engaging in efforts to improve community environments, CCHHs can improve the health and safety of their patient population, improve health equity and reduce the need for medical treatment.

The “Primary Care 2025” report offered multiple scenarios for what health care might look like a little more than a dozen years from now. Scenario 3 (“Primary Care that Works for All”) describes a future in which CCHHs provide the model and “health-care providers deliver primary care while also working with public-health officials and the community to create the social and economic foundations of health throughout the community.”

The CCHH model is of great interest to our Health team. One of the critical motivations for our Safety-Net Enhancement Initiativewas to foster new models for community-health centers to move beyond the clinic walls to address population health: in other words, to integrate community prevention into patient care.

Closely coupled with this idea was the requirement that the community clinics needed to have key partners, such as a local health system or public-health department, as well as other community and social-service partners. Since there are so many different sectors – environmental and social factors – that influence health and wellness, community prevention calls for and requires a collaborative approach and strategy.

But this got us thinking…  

Why should this idea be limited to community health centers and other community-based primary-care providers? Why couldn’t the CCHH concept be applied to larger health systems as well ­– community-centered health systems?

The Institute for Healthcare Improvement’s “Triple Aim” is widely considered the standard for defining the goals of a high quality health-care system. The Triple Aim seeks better care for individuals, better health in populations, and lower cost to the improvement of care.

The health system knows quite a bit about patient care and ways to lower costs, but has yet to tackle improving population health -- at least in the way we think about this. This will require getting outside hospital walls and engaging multiple sectors to address the manifold determinants of health.

In future posts, we will continue this thread and also invite other experts to comment: Can we create community-centered health systems?

(Fukuzawa is the director of Kresge's Health Program.)