ProMedica Taking Comprehensive Approach to Social Determinants of Health

• In all ProMedica care settings, patients were asked to self-identify social needs in 14 categories: 85% of patients completed the survey before seeing their provider, 43% of patients identified a social need, and 16% of patients had social needs in four or more categories.
• More than 18,000 connections were made to ProMedica’s food clinics, financial coaching, social programming, educational opportunities, and other SDOH interventions.
• The top three SDOH risks identified in primary care settings were social isolation (34%), financial (22%), and food insecurity (15%).

HealthLeaders recently spoke with ProMedica President and CEO Randy Oostra, DM, about the health system’s approach to SDOH and most recent SDOH partnership with Fresno, California-based Bitwise Industries. Following is a lightly edited transcript of that conversation.

HealthLeaders: Why has ProMedica decided to play an active role in addressing SDOH?

Randy Oostra: About a decade ago, we were doing some community needs assessment work around obesity, and we started an educational program in the schools. The folks who were doing the training asked for a meeting; and at the meeting, we expected to hear great things about the work we were doing. But the trainers said, “We have a problem—these kids are hungry. It is difficult to talk about nutrition when the students are hungry.”

We got more and more impressed that if all we did was take care of people clinically, we really were not addressing their health and wellbeing. We started looking at the social determinants of health. We knew that 20% of a person’s health is related to what we do clinically and 80% is related to other factors—primarily social determinants of health.

We needed to look at total health and wellbeing. So, we started screening for hunger. Then we started screening for more than a dozen social determinants of health. Then we realized that if the screening was good for our patients, it should be good for our employees. So, we started screening our employees for social determinants of health, and our efforts kept building from there.

What we found among our employees was that they had tremendous social needs, and it impacted recruitment, retention, productivity, and healthcare costs.

HL: What are the primary social determinants of health initiatives at ProMedica?

Oostra: We have partnered with a company in Ann Arbor, Michigan, called Kumanu that we made an investment in. They have a screening tool that looks at social determinants and personal determinants of health such as resilience and a sense of purpose.

We were fortunate enough to get a large gift from a philanthropist that helped us establish the Ebeid Neighborhood Promise program, where we built an inner-city neighborhood grocery store and have financial opportunity counselors.

We have built out a team of folks who live across the country, and the idea is to have intervention specialists in all of the social determinant areas. So, what started out as a passion around health and wellbeing has been built out to specialists who can support people who want to do interventions. We just helped another nonprofit grocery store to open, so we are doing consulting work in that area.

We work with a data analytics company called Socially Determined. We have a loan pool for minority- and women-owned businesses. We work with the Local Initiatives Support Corporation, which is a community development financing institution based in New York. Community development financing institutions are organizations that can help you invest where banks will typically not help you invest.

We have a lot of initiatives around housing. We are doing some specific fundraising for housing in neighborhoods such as the Junction Neighborhood in Toledo.

We are spending a lot of time on education, not only in pre-K but also in tutoring and programs that give people help in going to college. We are starting a science, technology, engineering, and math high school in the fall with the Toledo Public Schools.

Our view is that we should not only be involved in social determinants of health but also be accountable in addressing and leading in social determinant causes in our communities. Who is better at looking at a comprehensive model for health and wellbeing than healthcare institutions?

HL: ProMedica recently announced a partnership with Bitwise Industries to open an innovation center in Toledo. Why did the health system decide to enter this partnership?

Oostra: Regarding the Bitwise partnership, if you can get a person a good job, you can change their entire life.

Bitwise teaches individuals who have not been in the technology industry tech skills such as coding and software, so that they can go and get tech jobs. Their targets are primarily women, minorities, and the LGBTQ community. They are in four communities in California, and Toledo is their first site outside of California. They go to underdog cities and create careers for people who have been underrepresented.

In Toledo, Bitwise is hoping to create 500 tech jobs within three years. That has been their track record in California. When you think about it from the perspectives of economic development, changing people’s lives, and giving people opportunity who have not had opportunity, the Bitwise partnership fits perfectly in that space.

We made a $2 million investment in Bitwise.

HL: Will the innovation center help fill positions at ProMedica?

Oostra: Yes. We are already in discussions with Bitwise about their software capabilities that can help us. They will provide an employment pipeline for us, especially in our innovation group because we have several startups that are tech-based. They also will help us fill a lot of IT jobs.

HL: How do you plan to measure the return on investment for the innovation center?

Oostra: There are a couple of ways that we will measure the ROI. We will not only measure ROI by job growth but also measure it by the number of startups that come out of the innovation center.

This kind of project does not necessarily get us a financial ROI, but it will get us a social, health, and wellbeing ROI, which our board has been very comfortable to invest in. We do not have endless resources, but we make purposeful investments in projects that are good for social determinants, personal determinants, and anchor institution strategies.