When neighborhood leaders convinced the big university hospital nearby to join them in a community improvement project, no one thought that would lead to a role in reform of the nation’s health care system. Four years later, though, the Southwest Baltimore Partnership finds itself immersed in a program necessitated by the Affordable Care Act – aka Obamacare.
Hospital reimbursement requires hospitals to fundamentally change the health care habits of its patients by discouraging costly emergency room visits and encouraging regular, preventive care check-ups.
"Many of our patients, they focus on today. I’m alive today. What do I need to survive today," explains Zina Kendell, head of the University of Maryland Medical Center's Transitional Care Unit. "It’s a behavior change. We’re trying to engage them to think about down the road. It really is changing the mind set and educating the community that the emergency room is for emergencies."
What her team attempts is virtually a 24-7 effort.
"We make all the phone calls for them. We advocate for them. We bring resources to them where they are," she says. "We teach them life skills."
The level of change is revolutionary—and not just for the patients.
Dr. Chuck Callahan, a newcomer to Baltimore, spent years working on what the science calls "population medicine" – measuring outcomes of care. What improvements were actually achieved in the effort to improve health and quality of life?
So impressed was he with the work already underway – and so impressed with the Southwest Partnership’s energy and enthusiasm for change – that Callahan moved into Union Square, one of the Partnership’s seven neighborhoods.
His presence in the community could have real as well as symbolic importance. It underscore the hospital’s commitment to the Partnership.
He says Zina Kendell and her skilled case workers are real change agents. They’ll be building an intangible but essential element of the transition from ER care to a more rational system – trust.
"We win this encounter one patient at a time. One episode to win back trust, to establish trust at a time. And that’s what the professional staff is really good at. They’re really focused on that," Callahan says.
He calls the U.S. health care system "notoriously de-synchronized and not well integrated."
"If we pause long enough to think about it, it is really archaic," he says. "As we move to a system that’s more integrated I think that’s the way we gain trust back."
Real change, it is said, tends to start from the bottom, with the people. Baltimore may be adding some flavor to that idea – even as it deals with its own severe health challenges.