Health leader shows how ‘place’ determines variances in health outcomes — and why states should care

Why would a health insurer pay for new bedding and curtains, as well as the removal of carpets, for some select households in Michigan? Because “place matters” when it comes to health — both in terms of costs and outcomes.

People in those households had asthma, Shannon Wilson explained during a July presentation at the Midwestern Legislative Conference Annual Meeting, and they were part of a larger community that accounted for an outsized portion of Priority Health’s asthma-related costs. By removing and replacing those items, while also connecting individuals in those households to health professionals and an asthma management plan, the health insurer thought it could reduce costs while improving lives.

The investment paid off.

“We saw about a 40 percent reduction in inpatient admissions, a 60 percent reduction in the length of time that someone stayed in the hospital, and almost a 40 percent reduction in [emergency department] visits,” said Wilson, vice president of population health for Priority Health.

The root cause of asthma-related visits had been addressed not only through a medical intervention, but by also understanding and then addressing place-based determinants of health. “We were able to really change the trajectory of those families,” she said.

She believes that success story provides valuable lessons for state leaders on health policy. One is to look “beyond the 20 percent,” referring to how much clinical care contributes to variations in health outcomes among the U.S. population. The other 80 percent is driven by individual behavior, socioeconomic factors and the physical environment.

Mold and allergens in homes. Lead in the drinking water. Communities that aren’t walkable. A lack of affordable housing options. Those and other place-based factors contribute mightily to health outcomes and costs.

“Today’s fastest-growing populations are the least healthy,” Wilson noted.

That means the cost of health inequities will rise and rise if not addressed; one study, for instance, pegs the current total cost at $320 billion and has it increasing to $1 trillion by 2040. “We have to get this under control; it is not a sustainable system,” Wilson said.

She urged legislators to consider adopting more place-based health policy strategies, using a three-step approach: 1) “Understand the context” and root causes of the inequities, 2) try interventions based on what you’ve learned, and then 3) evaluate whether they worked.

“We have to get to a place where people have the opportunity to be as healthy as us,” Wilson said, regardless of where they live.