Women’s health is about much more than health care, so driving better outcomes needs to involve more than hospitals and other traditional care settings. That’s a core idea behind community-based health, or the delivery of medical care and education in community settings.

Decades of research have shown that community-based care can be an effective, sustainable approach to mitigating the negative effects of social factors (like food security, housing, transportation, safety and education) that can heavily influence health outcomes. And it’s a powerful means by which to reach people who might not otherwise seek or access care – a crucial tool for health engagement, considering that just 55 percent of privately insured individuals report a regular, office-based source of care.¹ Rather than simply react when individuals seek out care for acute issues, proactively engaging them where they are at may be able to prevent some of those health issues from even happening.

Public health officials and policy experts have long leveraged the power of community-based health to drive changes in population-level outcomes. But as the pandemic and social justice movements of the past two years bring a new and necessary focus to health inequities, employers, health payers and providers are putting more muscle behind the push for community-based solutions.

As a 2021 Deloitte report on health equity points out, “more and more health plans and health systems are bridging health and social services to address drivers of health through technology-enabled referral networks with local community organizations.”² Health plans are also a source of critically needed funds for such programs. In 2021, for instance, Optum awarded $1.4 million in grants to community organizations focused on maternal health outcomes.³

“It’s no longer about proving the model,” said Patrick Conway, MD, CEO of Care Solutions at Optum, at a discussion on the future of community-based health. “It’s about how we scale a model that cares for people’s physical, mental and social needs for everyone across America from the low acuity to the highest complexity. And how we manage health equity, better health outcomes and a lower cost of care system that centers on individuals and families in their homes and communities.”

An ecosystem of change

The United States is in the throes of a maternal health crisis – one that disproportionately affects Black women and women of American Indian and Alaskan Native descent.⁴ Those racial disparities persist even as education levels rise: Among college graduates, Black women face a pregnancy-related mortality rate that’s five times higher than the rate of white women.⁵

Women’s health is far broader than maternal care, of course. But this corner of care is a rich proving ground of what’s possible with the right community-based ecosystem in place. Community-based birth workers, such as doulas, midwives and lactation consultants, are known to improve both maternal and infant health. Women who are at high risk for adverse outcomes are two times less likely to experience a birth complication if they receive care from a doula.⁶ They’re also four times less likely to have a low-birth-weight baby and are more likely to be satisfied with their health care.⁷

Such community-based providers often fill critical gaps in the health care system, offering emotional, physical and educational support across the perinatal period for women who might not have transportation or other means of accessing quality health centers. For example, when researchers at the Urban Institute examined maternal morbidity rates for Black women in Washington D.C., they found that one of the wealthiest and predominantly white wards has 12 prenatal care facilities, while predominantly Black wards – including one that had the highest birth rate in the entire city – had just four prenatal care facilities.⁸

Reaching these women through community-based health isn’t simply about convenience; it can mean the very real difference between a healthy pregnancy and birth, or any myriad number of negative health outcomes.

Amplifying efforts

No one employer or payer or provider can be an expert on every community – and they don’t have to be. The fight to erase health inequities must be a collective one, with employers, payers, providers and community-based organizations amplifying each other’s efforts in order to drive better outcomes.

For their part, health payers recognize that community care improves member health, and can have a positive ripple effect on the health of an individual’s family and friends. Employers, too, understand that by choosing health plans and offering benefits that incorporate social services and promote the adoption of community-based organization (CBO) partnerships and programs, they can help better engage and address the social determinants of health (SDOH) related challenges of their employees.

CBOs work because they intimately understand the needs of the local population. And because these organizations are typically trusted by individuals in their community, they can often engage residents better than payers and employers can, providing targeted supports to drive better health outcomes. For that reason, they are a keystone of decentralized care delivery models now emerging around the country.

As Optum Care Solutions CEO Conway says, “When we’re able to put those sets of care delivery models together to address the whole person, that’s when the magic really happens in terms of the impact on the person, the family and the caregivers we’re serving.”

References

1. Duke Margolis Center for Health Policy. “A pathway for coordinated, affordable employer-sponsored health care.” September 20, 2021.
2. Deloitte Insights. Activating health equity: A moral imperative calling for business solutions. April 2021.
3. News release. June 30, 2021.
4. Kaiser Family Foundation. “Racial disparities in maternal and infant health.” November 10, 2020.
5. Commonwealth Fund. “Community-based models to improve maternal health outcomes and promote health equity.” March 4, 2021.
6. Urban Institute. “Evidence-informed and community-based recommendations for improving maternal health outcomes.” April 2021.