Erica Coletti: Why community partnerships are so critical for promoting health

It is well known that healthcare provider organizations alone cannot solve all the problems facing the U.S. healthcare system, given that many of those problems – including health inequity, food insecurity and senior isolation – reflect larger societal issues. The solutions, therefore, will depend on forming partnerships that connect providers with the wide range of other organizations that can help to meaningfully tackle those broader societal concerns.  

We are beginning to see an increase in such partnerships, advanced in new and creative ways by organizations dedicated to promoting cost effectiveness of health for all Americans. One such organization is Healthy Alliance, headquartered in Schenectady, New York. 

Erica Coletti, CEO of Healthy Alliance, describes the organization as being dedicated to addressing people’s social needs that, if allowed to go unchecked, could lead to medical problems.  

Q

Can you give us a quick overview of the type of work Healthy Alliance is doing? 

Coletti  

Sure. We have been growing a coordinated network of health systems, hospitals, behavioral health providers, and human service organizations for the past several years with a core focus on improving health collectively. We created an IPA [independent practice association] in late 2018 early 2019, which started in the capital region of New York and now spans 25 counties in upstate New York. Our network includes around 600 provider sites offering 1350+ diverse services and programs (not only physical and mental health services, but food and housing and financial support – things like that) to community members in need.  

Q

So it sounds like you are the poster child of partnerships!  

Coletti  

Yes — very much so. We manage this network in collaboration with organizations like Adirondack Health Institute in northern New York and Inclusive Alliance in the central New York region. We don’t want to re-create things that already exist; we want to really leverage what’s out there.  

Q

HFMA has recognized the need for our nation to be focused on promoting health of our population. And some of the ways that we can do that are through promoting health equity, addressing social determinants of health and access challenges and working to solve things like food insecurity, senior isolation and all those things that contribute to greater sickness in our society. What kind of actions are needed for our nation to begin to make more meaningful progress in addressing these issues? 

Coletti  

I can start at the 50,000-foot level, and then we can get down to some just very simple examples.  
 
I think, historically, a lot of money and resources has continued to be funneled in a very siloed fashion through traditional systems, and we are expecting this pivot to evolve. But I truly believe that the whole framework needs to shift because the fragmentation — running dollars through health plans or through particular systems for certain populations, where somebody might have a certain plan card and someone else has a different one — doesn’t really address the community problem. So, for example, even in the same family, one person with food insecurity might be in a food insecurity program under a health system or a health plan while that person’s sister might be under a different program that lacks the same eligibility. That kind of continuing fragmentation is very costly, because having so many of those little programs means more administration and overhead; it just amplifies rather than addresses the issues over the long term.  
 
 
So that’s at the highest level. What the health systems and plans need is help with this process to reduce that fragmentation while not having to re-create some of those programs. So our role is not to be the direct service provider but to be a support by being an expert in the resources and opportunities in the community for those health systems and plans.  

So, for example, if an individual comes into the ED and is seen by a social worker, the social worker can do a social care screen and then send it to our navigation team, whose job it is to help connect that person with the community organizations that can provide them with the services they need. Our team is an extension of every organization and care team in our network. We do the work for them in finding accessible resources that meet a community member’s need; that way, folks like social workers in the ED can focus on doing what they do best, while our team does the work of connecting the person in need to other providers and organizations that can help. 

Q

So in other words, you’re saying a health system would look to you to be a facilitator for them of things that might just be more cumbersome for them to try to do themselves?  

Coletti  

Yes. It requires a different kind of an expertise, and it’s neither logical nor cost effective to require every health system to pour resources away from patient care to develop its own set of community resources in a silo. 

Q

That very much aligns with HFMA’s focus on cost effectiveness of health, which we perceive to be a societal issue, not just limited to the healthcare industry. So we need partnerships to promote health meaningfully. How would you expand on that idea?  

Coletti  

Sure. You have to think of all the people involved; there are so many. We’ve been fortunate in that Healthy Alliance was seeded out of New York State’s Medicaid Section 1115 Medicaid Redesign Team (MRT) Waiver. And the governance structure was made up of individuals from health departments, mostly at the county level, as well as from health systems, federally qualified health centers (FQHCs), community-based organizations, and independent practitioners.  
 
So having those folks at the table to play a really strong role starts a really productive conversation. We’re looking now to expand that to including health plans. And to your point, it extends even to education systems. We are starting to bring in schools and labor organizations. It starts to build out because you have to look at it from the center of the human experience, which is the community member. And it takes a while just breaking through some of those legacy issues. Many people really want to help the individuals, and that includes health systems, but they can’t know everything that’s going on everywhere. So how do you get the right people in the room? That’s a key question for us. 

Q

How would you describe your reach in terms of the total area that you’re serving? And do you know to what extent other organizations are doing similar things around the nation?  

Coletti  

We have a pretty broad reach. At this point, we have connected over 25,000 individuals through our network, but we also know that there’s a lot more going on out there. Some organizations like ours have come up a bit nationally, like Central Ohio Pathways Hub and Camden Coalition of Healthcare Providers. But a lot of the work has been driven more through sponsorship of health plans or health systems, and that tends to limit their focus because it’s all about the plan or system and their attribution.  

Q

Would you say that’s because our system is so fragmented, so they have to work within their own limited framework? 

Coletti  

Yes. I can’t say that we have really seen enough of this type of activity. We aim to just keep going and see how many more can join us so that it’s really about getting to the community members. When we talk about health equity, how do we also demonstrate that health equity is being addressed? Sometimes you just have to start with the basics, like making sure you are capturing demographic data. Are we doing those really tactical things? 

Q

Can you offer some examples of success stories, where you are beginning to make a difference? 

Coletti  

Sure. I can think of a real boots-on-the-ground story where we were able to connect an individual to a community organization. As a result, the person was provided with a bus pass for a job interview and ended up getting the job and being able to pay back their past due rent. And then we helped that person with a security deposit for more stable housing. And what’s significant is that this was done without much money. We know health is so much more than just medical care. Our work is focused mainly on meeting community members’ social needs — like access to transportation, healthy food and health insurance— before they turn into costly medical problems. 

Q

How did you get connected with that person? What was the process?  

Coletti  

We believe there’s no wrong door. The person actually came as a referral from one of our health system partners into our navigation center, where we got them connected to a community organization. So we address their demographics, their location and what the need is, and then we figure out and deal with the eligibility issues. We use a system, a tool called Unite Us, as our referral platform technology — where we get some of the information. But that’s just the start. While one partner is working with the individual directly, we can work with another partner to provide the housing and household goods — it’s about putting the pieces together.  
 
So that’s an example of someone coming in through a health system. But people can come from different sources — like local food pantries, schools, shelters and other community-based organizations and entities — and we want to help each community organization stay focused in the area they serve. That said, individuals can also reach out to us directly, either through the web or by calling us. We haven’t done a ton of marketing around that yet, but we’re looking to do more.  

Q

So somebody in need could go straight to you?  

Coletti  

Yes. But we don’t want to bypass having people coming to us from other sources, such as a health system. We just don’t want there to be a wrong door.  

Q

What advice would you have for finance leaders of hospitals and health systems across the country on how they ensure their organizations are playing a role in such efforts?  

Coletti  

I know they are dealing with incredible challenges. And this might sound simplistic, but I think health system finance leaders can easily underestimate the benefits of partnering with others in the community or leveraging other organizations like ours. There are opportunities to focus on things like transitions of care or discharges, where human services could really play a strong role from a financial perspective. I am thinking of homeless individuals, for example, who could be discharged but need to go somewhere that provides a little bit more care. The community can offer them a much less costly option. I would advise hospital and health system finance leaders to look for opportunities to partner with organizations like ours. They really need to see it’s about delivering more value for their patients. 

Q

So it’s part of that same larger message we are hearing so often around value: that our healthcare system is simply spending too much money, and it cannot continue the way – and that as much as someone might want to say we can just keep going the way we have been, if we don’t begin to transition to value, we may be forced to do it eventually through policy changes. 

Coletti  

And thank you for saying that, because it is 100% of the issue. A conversation I just had earlier today, about how so much more money and funding was going into these legacy systems and the fee-for-service model and how the transition to a new, value-focused mindset has been very slow. I say you just really need to rip off that Band-Aid and really start focusing on value. And that’s going to require the kinds of partnerships we are trying to promote.