In my experience as a physician and healthcare leader, I’ve often encountered people whose needs fall outside the scope of our healthcare system. Frankly, for many years, while I understood the magnitude of those needs and the need to fulfill them, I felt mostly powerless to address them.
Then I joined the board of the Make-A-Wish Foundation, which grants wishes to children with critical illnesses. That experience made me wonder if it was possible to create a program within the healthcare industry that could grant wishes and fill in these gaps for older adults with critical illnesses.
The answer is yes.
About a year ago, SCAN Health Plan, the not-for-profit Medicare Advantage plan that is part of the diversified healthcare organization that I lead, established SCANkind, a program designed to provide support to older adults in the communities we serve with pressing health needs that aren’t covered by their health plan benefits.
After a transformative first year during which we addressed 208 cases, SCANkind has evolved in ways we never anticipated. Our experience has broadened our understanding of our organizational capabilities, the complex needs of our communities, and the shortcomings of our health system—learnings I am sharing below in the hope that others will use them to find new ways to offer common sense health-related services and support to the communities they serve.
Learnings
1. People’s needs are broader than you realize. We funded SCANkind with an initial grant and assigned our Independence at Home community benefit team to manage it. We asked SCAN staff and community outreach organizations to submit deserving cases to us. And then we got to work.
An obese, diabetic woman taking weight loss medications did not have a scale with which to weigh herself and could not afford one. So, we bought her a scale.
A 69-year-old woman who couldn’t afford a refrigerator was prescribed life-saving medications that needed to be kept cold. We had a small refrigerator delivered to her apartment.
A 78-year-old woman couldn’t prepare food in her kitchen because of an infestation of rats and roaches. We found a cleaning company to make her home habitable.
Not one of these cases would be addressed in a routine manner anywhere in our established clinical pipeline. And yet, were we to ignore them, they would certainly have resulted in poor health outcomes.
2. This is difficult, time-consuming work that requires many resources. It’s not that hard or expensive to send appliances to people’s homes. Cleaning crews are abundant.
But an astonishing number of urgent requests have required huge exertions of manpower. (Notably, they often don’t require a significant outlay of funds.) For example, a landlord, eager to evict an 81-year-old man who had lived in his building for years, refused to accept the tenant’s rent checks. He falsely accused the tenant of not paying rent and created a hostile environment that likely amounted to elder abuse, something we as a health plan are legally obligated to report.
SCAN’s legal department spent hours with the man’s social workers to mount a defense in court. I’m proud to say they prevailed. Then a second team worked with several municipal housing departments to find a subsidized home for the man. Next, yet another team worked to locate a moving company to pack and transport the man’s belongings to his new home.
In another case, a SCAN member ran out of a lifesaving medication just before Thanksgiving, and because of holiday closures, her mail-order renewal wasn’t due to arrive on time. We initially thought we could just pay to have her local pharmacy process the script.
It took 17 SCAN employees—attorneys, pharmacy specialists, finance and disbursement specialists, translators and others—working around the clock (at one point joining a nine-way after-hours conference call) to get the woman a $40 medication before the Thanksgiving holiday.
The takeaway from these examples is that no organization should move toward providing non-traditional healthcare services with the belief that doing so will be easy. To put it bluntly, it’s healthcare: everything worthwhile is hard.
3. Resources exist. But they’re hard to find. We’ve spent only a tiny fraction of the money we initially granted the SCANkind program. That’s not for lack of trying. It’s because we’ve often found that clients’ needs can best be fulfilled by connecting them with existing resources.
For instance, we’ve received multiple requests to provide people with grab bars in their showers. We were able to assist them most efficiently by referring them to a great organization called Helping Hands, which helps seniors out with home repairs.
We received a request from a 71-year old woman who needed a new electric wheelchair and wasn’t eligible to receive one under her plan. Instead of a new purchase, we turned to the Pushrim Foundation, which helps people with spinal cord injury, neurologic disorders and other mobility impairments. They not only delivered a wheelchair to the women, they also connected her to a rehabilitation hospital in her area, which created a holistic care plan for her.
When fires ravaged the Southern California communities of Pacific Palisades and Altadena earlier this year, we fanned to help distribute more than 500 kits with hygiene products, food and other items to affected people. But we knew those items would only get people through a few weeks at most, so we connected displaced families with the disaster recovery organization Bright Harbor to help them navigate the recovery and rebuilding processes.
The existence of these organizations is wonderful. And though we’re developing new relationships with them every day, it’s taken a dedicated, full-time staff more than a year to identify the ones we know about. It’s alarming to think how many seniors could use services like these but lack the ability to connect with them.
4. You can’t help everyone. With creativity and determination, we’ve been able to provide an array of health-improving solutions to seniors who desperately need them. Unfortunately, we have many more stories of people we couldn’t help.
One reason is that the healthcare industry is governed by the Anti-Kickback Statute (AKS), which prohibits anyone from requesting, receiving, offering, or paying kickbacks intended to generate health care business. I get the idea. Medicare and Medicaid beneficiaries should not choose their health plan and medical providers based on gifts and other kickbacks. And honestly, I wouldn’t want to work in an industry where it might be legal for me to pay someone to sign up with my plan.
Determined to comply with the AKS (and all other applicable laws), we’ve operated SCANkind in line with carefully implemented safeguards, including limits on the value and type of support we offer. In general, we’ve limited our work to preventing health-related catastrophic life events.
So, for example, when a 95-year-old woman couldn’t afford to hire a gardener to mow her overgrown lawn, which had become a fire danger, we could not help because of concerns that doing so would run afoul of the AKS. (If you live in Riverside County, own a lawnmower and would like to volunteer your services, DM me on LinkedIn.)
Similarly, a 69-year-old man with disabilities needed hand controls installed on his car. We have been unable to locate a community organization that offers this sort of highly specialized and expensive work free of charge.
And then there are the housing requests. In California, where most applicants reside, the median rent is $2,750—nearly 40% higher than the national median. Six out of ten older adults in the state are considered rent burdened. “Housing is Healthcare” is a rallying cry often heard in health circles, and research shows high rents correlate with rising homelessness among older Californians, who often must decide whether to buy food and medicine or pay for housing.
As much as we would like to help individuals whose health is imperiled by rent burden, under the AKS, that kind of life-changing assistance could be viewed as an impermissible kickback. (We refer these requests to the many community organizations that specialize in housing assistance.)
It’s worth noting that CMS recently issued a call for public input on ways to “reduce unnecessary administrative burdens and costs, and create a more efficient healthcare system.” In that spirit, I suggest we look at updating the AKS to allow greater flexibility for not-for-profit healthcare organizations to offer items or services, whether to members, patients, or the community at-large, when they can demonstrate the clear health-affirming value of those benefits. Loosening these restrictions would encourage proactive interventions that could prevent catastrophic and costly health events for vulnerable older adults.
The Social Determinants of Health.
The term “social determinants of health” has been bandied about for years. SDOH are the non-medical factors that affect health outcomes. People seem to agree that it’s imperative for healthcare organizations to address these factors. Many healthcare organizations want to address these factors. But they soon learn, as we have, that doing so is difficult.
My message to them is to keep going. As I told my staff, progress over perfection. HealthCare should be about more than just medical treatment—it extends to ensuring that people have the resources they need to lead independent, fulfilling lives.
What’s more, addressing SDOH isn’t just good for health; it’s good for healthcare. By tending to non-medical needs, programs like SCANkind can help relieve the burden on our oversubscribed, expensive healthcare system, enabling people to live healthier lives without frequent medical interventions.
Which is what I think of when I make a wish.
