By Rosanne Haggerty and David Figliuzzi
This post originally appeared on the Health Affairs GrantWatch Blog on Sept 15, 2014.
The story begins with the failure of the economic engine—the relocation of a factory, perhaps, or the closure of a mine. Soon, joblessness, violence, and the deterioration of housing conditions follow. The impact on individual health levels can be devastating as rates of mental illness and substance abuse increase and more people do not manage their chronic conditions. Ultimately, life expectancy there drops well below that of surrounding areas.
Distressed neighborhoods can be found in cities across the United States. Always, the metrics tell a similar story.
But these communities also possess formidable strengths—informal problem-solving networks comprised of local residents, or vibrant churches and mosques with deep roots and organizing power. Organizations hoping to make positive change must inhabit the middle space, gathering a community’s strengths together around its biggest challenges, bringing in the right outside skills and resources, and creating opportunities for collective problem solving.
The Cigna Foundation is partnering with Community Solutions, a New York-based nonprofit pursuing this approach in the Northeast neighborhood in Hartford, Connecticut. Among the poorest neighborhoods in the country, Northeast stands in sharp contrast to the wealthy suburbs found in other parts of the Constitution state. Households in Northeast are disproportionately low income, African American, female and single parent. Well-paying job opportunities are scarce. The emergency department (ED) at nearby St. Francis Hospital is the primary source of health care for this largely Medicaid-insured population.
The centerpiece of this neighborhood used to be the Swift Factory, which was in its day a dominant source of gold leafing for state capitol buildings and historic landmarks across the country. In 2004 the factory shut its doors for the final time, and a neighborhood already in distress fell on even harder times.
Today, Community Solutions is placing a bold bet on a plan to revitalize the factory building as a hub for employment, entrepreneurship and health care services. The nonprofit is also engaged in innovative efforts to coordinate health care and social services more effectively throughout the neighborhood of Northeast and to help residents restore key community assets, such as a park designed by the well-known landscape architect Frederick Law Olmsted. The end goal is a dramatic turnaround of the entire neighborhood, led by, and for the benefit of, its current residents.
The Cigna Foundation recently announced that it would award Community Solutions a $100,000 World of Difference grant, a grant reserved for the foundation’s signature partners. Cigna chose Community Solutions, in part, because of the success of the innovative care coordination work the group has already piloted in the community. Like many neighborhoods where Medicaid is the primary payer, access to primary care in Northeast is sporadic. It is not uncommon to meet residents who have visited the ED more than twenty times in a single year.
Partnering with nearby St. Francis Hospital, Community Solutions implemented a pilot program with a neighborhood-based social worker to determine if social interventions (such as help with navigation of the benefits system or help with finding a primary care provider, or even simply driving someone to a grocery store) could make a difference for the twelve highest utilizers of the local ED. Nine months later, ED use is down more than 50 percent among this group, and costs have dropped dramatically.
When Cigna and Community Solutions met, we realized we could use the same tools that Cigna, the health insurer, uses to improve the health of its customers to scale Community Solutions’ work to help Northeast turn itself around. Cigna opted to approach the effort as it would when working on behalf of a client—by using analytics and interventions that have demonstrated success in improving health and reducing costs for employer groups.
Cigna and Community Solutions together approached the State of Connecticut to request deidentified Medicaid claims data for those living in Northeast’s zip code. The ability to collect, store, and analyze available data, identify large-scale intervention needs, and create an economic business case for new investments that improve the health of residents and their experience of less costly care are skills uniquely held at Cigna—and skills that stand to multiply the exciting impact that Community Solutions and local residents are making together in Northeast.
Cigna is also lending other skills-based support to the neighborhood, including social media program development to engage youth and introduction of a food security program to the local elementary school. Cigna’s vocational rehabilitation specialists are developing a pilot program with Community Solutions to help residents get back to work; its informatics specialists are assisting with data collection and analysis; its physicians and nurses are weighing in on the development of clinical interventions; and its actuaries are building the business case for community reinvestment.
Perhaps most exciting, Cigna and Community Solutions are codeveloping a neighborhood health risk assessment. While Cigna has demonstrated success in creating similar tools for employer clients, Community Solutions has had experience in showing how problematic social determinants of health can be overcome in a place like Northeast Hartford. How does employment status affect health, for example? Is substandard housing contributing to chronic conditions? What legal matters are interfering with residents’ ability to receive needed services?
Cigna is learning new things from Community Solutions about what it means to engage locally and individually with community organizers, faith communities, school systems, city officials, and nonprofits in aiming to make a 360-degree change in health care. Together, we are removing barriers and improving processes to get coordinated help faster to people who need it.
We plan to track the following metrics:
* Decrease in potential years of life lost, with an increase in life expectancy in the long term;
* Increase in use of preventive care;
* Decrease in total health care costs among the costliest Medicaid patients;
* Increase in “well-being” scores for residents, with a score methodology being developed.
The Cigna–Community Solutions partnership is a unique and powerful combination of grassroots neighborhood improvement work driven by an innovative nonprofit and the tremendous capacity of private-sector tools and skills. Together, we are creating a new model for community development with far-reaching potential. If we can succeed in helping one distressed neighborhood turn itself around, it’s a hopeful sign for communities across the country.