One of the biggest US health insurers created a new kind of job to make sure patients have enough to eat, and the change has already saved $4 million
Blue Shield of California Promise Health Plan
- Doctors are at a loss when patients come in and report social isolation or struggles to access food, safe housing or dependable transportation.
- So Blue Shield of California Promise Health plan created a new kind of job to help: "social needs care specialists" to whom doctors could refer patients.
- The change, which was spearheaded by senior medical director Chris Esguerra, saved the health plan $4 million last year in avoided hospital and emergency room visits alone.
- Business Insider just named Esguerra to our list of 30 young leaders who are transforming the industry.
- Click here to see the full list of the 30 people under 40 who are transforming healthcare.
- Click here for more BI Prime stories.
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Imagine you're a doctor, and a patient comes into your office one day.
This individual has been diagnosed with diabetes, a chronic condition in which food plays an enormous role. Yet he or she also doesn't have enough to eat, and it's affecting their health.
What do you do?
That's the gap that Chris Esguerra's team at Blue Shield of California Promise Health Plan set about addressing last year at the two primary care clinics that the health insurer owns and runs. The solution they engineered saved at least $4 million in 2018, and serves as an example of how to create change in a complex and difficult-to-move system, Esguerra said.
These kinds of social needs are widely recognized as having an impact on an individual's health, but addressing them is difficult.
Courtesy of Chris Esguerra
Esguerra, who is 39 years old and has a background as a psychiatrist, came to Blue Shield of California in late 2017. He and his team at the health insurer's Promise Health Plan focus on members covered by the government programs Medicare and Medicaid, who often have a number of health conditions and also need different kinds of social support.
In recognition of the work Esguerra is doing to redraw the traditional lines of healthcare, Business Insider just named him to our list of 30 young leaders who are transforming the industry.
Working within medicine's referral system to create a new type of specialist
For patients who need an additional medical perspective, doctors refer them to other physicians - like specialists in areas such as cancer and heart disease.
So Blue Shield of California Promise Health Plan created the same concept for "social needs" like food insecurity, safe housing, dependable transportation and social isolation, employing community health advocates and social workers as "social needs care specialists."
The health plan had never had this type of role before it was implemented at the end of 2018. Today, three specialists work across the health insurer's two clinics, and new hires should bring the total to five, Esguerra said.
Health advocates like Stephanie Johannesmeyer and Amilcar Ramirez work as part of a team of just under 30 doctors, nurses and more who treat a population of 11,500 in a high-needs part of Los Angeles.
Blue Shield of California also aims to try this out on a wider scale. It is currently hiring nine specialists to do the same for its roughly 410,000 members in Los Angeles and San Diego counties who are insured through Medicaid.
Caring for hunger and loneliness made patients healthier and saved money for Blue Shield
Esguerra and his team initially worried this system would be costly. At the start, they employed one "very burnt out" social worker, but knew there was more work than one person could handle, Esguerra said.
Yet it has paid off, saving the health plan $4 million last year in avoided hospital stays and emergency room visits alone, Esguerra said.
This shows that "folks are less encumbered and healthier, and the result is they don't have to go to the hospital or emergency room as much. And as a result that has savings to the system," he says.
The case study also speaks to the importance of building change into an existing system. By using the language of medicine to explain the new role, "people can see there is this broader way of going about things," Esguerra said. "Now, it's not just me championing it. It's our physicians saying, 'How can we do more?'"
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