Exploring the Evidence of Medical Financial Partnerships March 7, 2018
Welcome Carmen Shorter Senior Manager for Learning Field Engagement Prosperity Now
Housekeeping ▪ This webinar is being recorded and will be available online within one week ▪ All webinar attendees are muted to ensure sound quality ▪ Ask a question any time by typing the question into the text box of the GoToWebinar Control Panel ▪ If you experience any technical issues, email gotomeeting@prosperitynow.org
Prosperity Now’s mission is to ensure everyone in our country has a clear path to financial stability, wealth and prosperity.
Our Unique Promise We open doors to opportunity for those who have been kept off the path to prosperity. We help people build wealth by making sure they have what they need to build a better future. We enable meaningful mobility through research, policies and solutions.
The Challenge Liquid Asset Poverty measures the percentage of those who lack savings to cover basic expenses for `` three months if job loss, a medical emergency, or other crisis leads to a loss of 37% income — $6,150 for a family of four Source: 2017 Prosperity Now Scorecard
Welcome Parker Cohen Dr. Adam Schickedanz Associate Director Pediatrician & Research Fellow Savings & Financial Capability David Geffen School of Medicine Prosperity Now UCLA
Introductions: The Upstream Lab Andrew Pinto Rose Wang Anne Rucchetto Director and Founder Research Coordinator Research Coordinator The Upstream Lab The Upstream Lab The Upstream Lab
Introductions: Johns Hopkins University Karl Johnson Dr. Barry Solomon Co-founder, Associate Professor of Pediatrics Financial Futures for Families Johns Hopkins School of Medicine Johns Hopkins University
Agenda ✓ Welcome and Opening Remarks ✓ Overview of MFPs ✓ Interview with The Upstream Lab ✓ Interview with Johns Hopkins University ✓ Audience Q&A ✓ Wrap Up and Next Steps
Medical Financial Partnerships
MFPs Defined ▪ What is a medical financial partnership (MFP)? ▪ An MFP is a shared commitment between a healthcare provider and a financial capability service provider to improve the health and financial well-being of a population. While the nature of these partnerships will differ depending on capacity and other local factors, they will typically include an assessment of financial needs and the provision of financial capability services.
The Upstream Lab
Exploring the Evidence of Medical Financial Partnerships Income interventions in primary care: Lessons from The Upstream Lab Andrew D. Pinto MD CCFP FRCPC MSc, Director Anne Rucchetto MPH, Research Coordinator Rose Wang MPH, Research Coordinator The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Inst, St. Michael’s Hospital @upstreamlab 14
Income interventions in primary care: Lessons from The Upstream Lab Outline 1. The Upstream Lab 2. Income Security Health Promotion Service 3. Online Financial Benefits Navigator @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab @upstreamlab 16
Income interventions in primary care: Lessons from The Upstream Lab Studies in progress Individual level – Access to adequate income • Income Security Health Promotion service • Online Financial Benefits Navigator • Basic Income pilot – Access to decent work – Access to legal services Organizational level -Robust SDOH data linked to EMRs to identify health inequities -E.g. Improve HIV primary care, improve cancer screening, improving care to transgender patients Neighbourhood level – Deploying prevention practitioners in neighbourhoods with SDOH toolkit – Community organizing in social housing Population/policy level – Building an advocacy coalition to influence employment laws during a policy window @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab Income security health promotion service @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab Income Security Health Promotion Setting: Patient Centered Medical Home in downtown Toronto More than 50,000 patients served at 6 clinic sites Broad cross-section of the community, with particular focus on serving marginalized population 30% of patients are living below the poverty line Objective of the ISHP service: • To directly improve the income security of individuals, families and the communities served @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2014/20140501e_hn @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab http://bmjopen.bmj.com/content/7/8/e014270 @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab Ongoing Evaluation 1. Assessing impact: survey at 1 month • Method: 5-10 minute telephone survey 1 month following discharge • Preliminary results @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab Evaluations 2. addressInG iNcome securITy in primary carE (IGNITE) RCT Method: pragmatic randomized control trial with 6 month wait-listed cross over Primary outcome: income at 6 months Secondary outcomes: QoL, community engagement, financial literacy, food security, health @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab Evaluations 3. Qualitative interviews Method: In-depth qualitative interviews with patients, health providers, and Income security health promoters to gain insight on service from different perspectives. @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab ONLINE FINANCIAL BENEFITS NAVIGATOR @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab Objectives • Develop new knowledge • Evaluate implementation • Use findings to modify new online tool for future use @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab Methods http://www.stmichaelshospital.com/medi a/detail.php?source=hospital _news/201 6/0727 @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab Key Findings @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab “It was helpful learning about government sites that I could go to for specific help to ease my life and check what I need help with; income, health benefits, training.” -Patient @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab Conclusions • Putting knowledge into practice • Improvements needed • Who’s best to use the tool? @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab @upstreamlab
Income interventions in primary care: Lessons from The Upstream Lab SPARK Study Brings together lessons learned from two areas: 1.Is routine sociodemographic data collection in primary care feasible, acceptable and useful? 2.If a patient screens positive for poverty, is a modest or robust intervention most effective? @upstreamlab
What other research would you recommend participants read? • Adler, Nancy E., et al. Addressing social determinants of health and health disparities . Discussion Paper, Vital Directions for Health and Health Care Series. National Academy of Medicine, Washington, DC. https://nam. edu/wp-content/uploads/2016/09/addressing- social-determinantsof-health-and- health-disparities. pdf, 2016. • Jones, Marcella K., Gary Bloch, and Andrew D. Pinto. "A novel income security intervention to address poverty in a primary care setting: a retrospective chart review." BMJ open 7.8 (2017): e014270.
What other research would you recommend participants read? • Aery, Anjana, et al. "Implementation and impact of an online tool used in primary care to improve access to financial benefits for patients: a study protocol." BMJ open 7.10 (2017): e015947 physician ‐ advocates." Medical education 49.8 • To, Matthew J., and Malika Sharma. "Training tomorrow's (2015): 752-754. • Pinto, Andrew D., and Gary Bloch. "Framework for building primary care capacity to address the social determinants of health." Canadian Family Physician 63.11 (2017): e476-e482.
What additional research questions would we like to ask? • How can individual-level interventions lead to system level changes supported at the policy level? • How can these interventions foster a sense of mastery, control, and efficacy for [research participants] who have been deprived of material resources (among other forms of capital; ex. cultural, social) • How might a longitudinal framework support better understanding of long-term impact on patients/clients/participants?
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