Can a Scalable Model for Improving Community Health Emerge from the Desert?

Alec Bojalad
SEPTEMBER 13, 2018
intermountain sdh,intermountain social determinants health,utah poverty healthcare,hca news

Red rocks, copper mesas and verdant patches of green dot the landscape of Washington County in southwestern Utah. The rusted hills of the Red Cliffs Desert loom to the north. The Virgin River to the south trickles on at its own inexorable pace, eroding the rock around it into ethereal art. To the east, Zion National Park is a natural metropolis unto itself, with thriving networks of rocks, hills, rivers and vegetation creating one of the country’s most picturesque vistas.

Southwest Utah is nature’s reminder to humanity that it can never be nature’s equal as an artist. The county seat, St. George, is evidence that we’ll continue to try anyway. The city is populated with the familiar, lovely landmarks of a thriving municipality dropped into the otherworldly landscape: a town hall, baseball fields, pristine, well-paved parking lots and reservoirs dug into the rugged earth well enough to pass for lakes. It’s as if someone built Main Street on Mars.

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Naturally, St. George is one of the tourism capitals of the Southwest. Visitors come from all across the country to take in the scenery. The city’s economy is growing. Home sales, commercial investment and the population are all on the rise. Like the nearby majestic red rocks, however, sometimes the imposing grandeur covers the cracks at the bottom.

Despite the booming economy, St. George has a higher percentage of persons and children living in poverty than the state average. This and other social factors contribute to unfavorable health outcomes for the disadvantaged.

“This is a population with two faces on it,” Southwest Behavioral Health Clinical Director Michael Cain says. “We have a high number of people that don’t have much in the way of income. A visitor comes and sees the recreational side of our community, but you have to live here to know about the other side. They need the kind of services that we have, and they need more of them.”

Research suggests that as much as 60 percent of an individual’s health profile can be attributed to social, environmental and behavioral influences. These social determinants of health include a person’s access to transportation, family and social support, level of education, income and housing stability.

Zip code has an unduly large influence on health outcomes, and the figure above confirms that social determinants are a very real — and very pressing — issue. That’s why Cain’s Southwest Behavioral Health and more than a dozen other Utah organizations have banded together to address those determinants.

A Targeted Social Approach to Healthcare

The Utah Alliance for the Determinants of Health is made up of healthcare, community and government-based organizations working together and sharing information to provide holistic, scalable solutions to improve the health outcomes of Utah citizens. The Alliance is embarking on a three-year, $12-million project to find ways to improve the social determinants of health for SelectHealth Medicaid members.

“I look out my window and see one neighborhood to the east and one neighborhood to the west, and there’s a life expectancy difference of 10 years,” Intermountain Healthcare Senior Vice President of Community Health Mikelle Moore, MBA, says. “It’s not because people don’t have access to healthcare theoretically — because we’ve helped create that access. We think there’s more we need to be doing to address people’s health needs.”

Intermountain is Utah’s largest not-for-profit hospital system, and its $12-million investment jumpstarted the creation of the Utah Alliance. Their journey has taken the Alliance, like many tourists before them, to the red rocks of St. George.

Intermountain collaborated with Medicaid to find two Utah communities in which to roll out this new model. Weber County, with Ogden zip codes 84401 and 84403, and Washington County, with St. George zip codes 84770 and 84790, were chosen after data revealed each had higher instances of second-generation welfare recipients, use of food assistance programs and use of mental health services. So far, about 3,000 people have been enrolled in St. George and roughly 5,000 in Ogden.

The group began with a collaborative needs assessment launched alongside state health departments and community-based organizations. Since then, it has also initiated a program called Neighborhood Pulse, in which researchers visit 15 homes and spend a few hours with subjects in Washington and Weber counties to better understand each community.

The process remains in its early stages. Intermountain and its associates are gathering information on how to best address these social determinants.

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