May 8, 2014

Transformative Pathways to Improving Health Care

Rebecca Onie, left; Sarah di Troia, center; Sonia Sarkar, right

Rather than simply scaling up, one nonprofit is "letting go" of its model and forming partnerships to change the US health care system.

By: Rebecca Onie, Sarah di Troia, Sonia Sarkar

Last year, Health Leads took a radical approach to developing our four-year growth plan: How little could we scale our model and still catalyze the health care system to address patients' basic living needs as a standard part of quality care?

How do we achieve impact at a scale that meets today's enormous needs? Explore Bridgespan research, insights from leaders, and more on the Transformative Scale Resource Center.

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We all know that there is a lot about the US health care system that simply doesn't work. But perhaps its most fundamental flaw is that it is designed to deliver medical care rather than to promote health. This is particularly true for the poorest patients. Every day, doctors across the United States prescribe antibiotics and other medications to patients who, for example, have no food at home or are living in a car. But of course, these patients need more than medicine to achieve health and well-being; lacking basic needs, many of them return—often with more serious illnesses that require more expensive treatment.

This doesn't have to be our reality. In clinics where Health Leads operates, physicians and other providers can "prescribe" food, heat, and other basic resources their patients need to be healthy, alongside medical care. Patients then take those "prescriptions" to our clinic waiting room, where our volunteers (Advocates) work side-by-side with them to access community resources and public benefits. This year, Health Leads' corps of nearly 1,000 college student volunteers will work to connect 14,000 patients and their families with critical resources in 20 clinics across 6 cities.

Our aspiration, however, is not simply to grow to hundreds of institutions and serve thousands more patients, but rather to change the way that institutions deliver health care so that it accounts for the realities of patients' lives.

Mapping the pathway to achieve this vision has required that we be diligent about two things: 1) choosing just the right level of growth necessary to collect crucial data and build a platform for system-wide change, and 2) leveraging our health care institution partners and other allies in driving this transformation

Managing Growth

In the for-profit sector, bigger is almost always better—it means more customers, greater profits, and increased market share. But anyone involved in scaling an organization—for-profit or nonprofit—knows that it's a messy business that increases organizational complexity. At Health Leads, we knew that we needed to be honest with ourselves about whether mass replication of our programs would be synonymous with greater impact and higher likelihood of achieving systems change.

In looking at other organizations that successfully had changed health care practices, we learned that peer-to-peer championship across health systems was far more effective and efficient than just increasing in size. This insight allowed us to take a minimalist approach to replication. Our intent is to partner with a small number of health systems across important market segments (such as academic medical centers, faith-based health systems, and for-profit hospital networks) and create models—"lighthouse" accounts—that can help us collect data and serve as reference points for other health care institutions.

Growing in this way enables us to focus on deep integration with our partners, and frees up valuable resources and management time to focus on catalyzing the ecosystem surrounding those partners.

Leveraging Partners

The second prong of our strategy parallels what Jeff Bradach and Abe Grindle identify in their Transformative Scale framework: unbundling and scaling cost-effective elements of a model, and changing public systems. To truly achieve a "new normal" in the health care sector, we must: 1) arm health care institutions with the tools and knowledge they need to integrate patient access to community resources and public benefits into health care delivery, and 2) drive market "pull" for such patient resource connections by providing sector leadership on this issue.

Pursuing these activities will mean that we need to "let go" of our model. We plan to pilot new fee-based advisory services that decouple specific elements of our model (our case management and resource technology, clinical integration strategies, and workforce strategies) and make them for sale to institutions. We also plan to pursue organizations with wide systemic reach (for example, electronic medical record vendors) as partners in disseminating these solutions.

Simultaneously, we will pursue a vigorous leadership and field-building strategy. This will involve enlisting our health care institution partners, our thousands of Health Leads Advocate alumni, and others to advocate for regulatory changes, provide sector standards for addressing patients' basic needs, and educate sector leadership about the value of this work.

Going small may not be glamorous. But if we can couple a powerful on-the-ground demonstration with pathways to change the sector, we will have the opportunity at last to transform health care for patients, physicians, and us all.

Rebecca Onie is the cofounder and CEO of Health Leads. She is a MacArthur Fellow, a World Economic Forum Young Global Leader, and a member of the Mayo Clinic for Innovation External Advisory Council. She has been recognized by Forbes Magazine, the Schwab Foundation, the Robert Wood Johnson Foundation, and others as a leading social and health care entrepreneur.

Sarah Di Troia is COO of Health Leads. She has extensive expertise in the scaling of and investment in social enterprises, previously serving as managing partner of New Profit and in leadership roles at the Center for Effective Philanthropy, Axxon Capital, and the Parthenon Group.

Sonia Sarkar is chief of staff at Health Leads. She cofounded Health Leads' Baltimore site in 2006, and is a World Economic Forum Young Global Shaper and a Boston Young Healthcare Professionals board member.

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