11/29/2018 Disclaimer Law: The views expressed in this presentation are When Medicine is Insufficient: the presenters’ own and do not reflect the Medical Legal-Partnerships view of any organizations I am affiliated with. The information included in this presentation Caroline Wick, Esq. MSPH should not be considered legal advice. UCONN CE Finale December 14, 2018 Disclosure Slide Learning Objectives Ms. Wick has no actual or potential conflict 1. Recognize social-determinants of health of interest associated with this presentation. 2. Define the term “medical-legal partnership” 3. List qualities that make medical-legal partnerships successful Agenda I. Social Determinants of Health ? II. MLP Model III. Healthcare Provider’s Role in the MLP IV. What if your organization is not part of an MLP? V. Questions 1
11/29/2018 Social Determinants of Health The social determinants of health are the conditions in which people are born, grow, I. Social Determinants of Health live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. http://www.who.int/social_determinants/sdh_definition/en/ Modifiable Contributors to Healthy Outcomes 10 ‐ 20% 80 ‐ 90% Clinical Social Determinants of Health Care • Health-related behaviors • Socioeconomic factors • Environmental factors (Hood CM, et al. Am J Prev Med 2016;50(2):129-135) Active Learning Question #1 Which of the following is a Social Determinant of Health that affects a patient’s cancer outcome? a) The patient’s genetic predisposition to breast II. Medical-Legal Partnership Model cancer b) The patient’s access to public or private transportation c) The patient’s body’s resistance to the most effective treatment d) The patient’s body’s response to drug side effects from chemotherapy 2
11/29/2018 MLPs: An Idea Born of Frustration Dr. Barry Zuckerman ? Reasons Healthcare Providers May Not Want to Address SDoH Legal Medical • Outside domain • Healthcare system overloaded • Effectiveness evidence? Screening (Magnan, S. NAM Perspectives 2017.) 3
11/29/2018 8 MLP Core Elements 1) Formal agreement Legal Medical Legal Assistance (Regenstein, M, et al. Health Aff. 2018;37(3):378-385) 8 MLP Core Elements 8 MLP Core Elements 1) Formal agreement 1) Formal agreement 2) Defined population 2) Defined population 3) Screening strategy (Regenstein, M, et al. Health Aff. 2018;37(3):378-385) (Regenstein, M, et al. Health Aff. 2018;37(3):378-385) 8 MLP Core Elements 8 MLP Core Elements 1) Formal agreement 1) Formal agreement 2) Defined population 2) Defined population 3) Screening strategy 3) Screening strategy 4) Staffing 4) Staffing 5) “Lawyer in residence” (Regenstein, M, et al. Health Aff. 2018;37(3):378-385) (Regenstein, M, et al. Health Aff. 2018;37(3):378-385) 4
11/29/2018 8 MLP Core Elements 8 MLP Core Elements 1) Formal agreement 1) Formal agreement 2) Defined population 2) Defined population 3) Screening strategy 3) Screening strategy 4) Staffing 4) Staffing 5) “Lawyer in residence” 5) “Lawyer in residence” 6) Lawyer provided training 6) Lawyer provided training 7) Information sharing (Regenstein, M, et al. Health Aff. 2018;37(3):378 ‐ 385) (Regenstein, M, et al. Health Aff. 2018;37(3):378-385) 8 MLP Core Elements Active Learning Question #2 1) Formal agreement Which of these is not a MLP core element? 2) Defined population 3) Screening strategy a) “Lawyer in Residence” 4) Staffing b) Information Sharing 5) “Lawyer in residence” c) Lawyer Provided Training 6) Lawyer provided training d) Policy advocacy 7) Information sharing 8) Designated resources (Regenstein, M, et al. Health Aff. 2018;37(3):378-385) Policy Advocacy MLPs Today https://medical-legalpartnership.org/partnerships/ 5
11/29/2018 Evidence of MLPs’ Successes IV. Healthcare Providers’ Role in MLP (Tsai J, et al. Health Aff 2017;36(12)2195-2203) Healthcare Providers’ Healthcare Providers’ Role in MLP Role in MLP • Note: Healthcare provider’s role will be • Referrals limited by patient-client’s wishes. Healthcare Providers’ Healthcare Providers’ Role in MLP Role in MLP • Referrals • Referrals • Write letters • Write letters • Testify 6
11/29/2018 Healthcare Providers’ Role in MLP • Referrals V. What if your organization is • Write letters not part of an MLP? • Testify • Answer questions What if your organization is not part of an MLP? ? Look for resources: • Local legal services providers • Local social services organizations Contact the National Center for Medical Legal Partnerships What if your organization Active Learning Question #3 is not part of an MLP? You are a pharmacist who works with elder, low- income patients. A patient comes to the window and says that Medicare is refusing to pay for his dental surgery, even though it was medically necessary. Your organization is not part of an MLP. To best assist him you could: Contact your alma mater a) Say I’m sorry and wish him a good day. b) Give him the website for local food pantries. c) Give him the contact information for a local legal services organization that works on Medicare issues. d) Offer to start a collection jar at the pharmacy. (Tyler, ET et al. J Leg Med. 2014;34:149-177) 7
11/29/2018 ? ? ? ? ? ? ? ? ? ? Questions? ? ? ? ? ? ? ? ? ? ? 8
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