ANDREW KRUSE and SUSAN TIPPETT
Director, Community Benefit, Ascension Michigan, and Director, Grant Administration, Ascension Michigan Foundation
For those negatively impacted by social determinants of health, overcoming the often complex barriers to meeting their health care and social service-related needs can be extremely challenging, but supportive navigation services can guide them to helpful resources.
Social determinants of health are the conditions in the environments where people live, learn, work and play that affect a wide range of health risks and outcomes.1 Spanning areas including health care access and quality, economic stability, poverty, food security, housing, transportation access and safe neighborhoods, these issues contribute to health inequities and disparities and have a significant impact on overall quality of life and well-being.2
The partners involved in emPOWER Genesee work together to enable vulnerable clients to access health, energy and financial services. Initiated by a team of nontraditional, cross-sector partners — Ascension Genesys, Consumers Energy and Huntington Bank — emPOWER Genesee is a strategic community collaborative launched in 2019 in Genesee County, Michigan. Designed to mitigate the social determinants of health that adversely influence personal health and well-being, the program recognizes that a vulnerable population within Genesee County has needs spanning all partner organizations that can be met with coordinated, accessible navigation services.
EMPOWERING CHANGE TOGETHER
To implement emPOWER Genesee, Genesee Health Plan — a nonprofit health care organization that provides basic health services to uninsured and underinsured residents of Genesee County — was engaged as the anchor organization to build a community navigation model to connect clients with services to address their social determinant of health-related needs. The collaborative's partners committed, and continue, to provide project oversight in monthly stakeholder collaboration meetings, support the project with financial and human resources, set data metrics with Genesee Health Plan, and establish a physical presence in the community for service access.
To reach people where they already go for services, emPOWER Genesee placed a Genesee Health Plan community navigator at Consumers Energy's direct payment center in Flint, Michigan. Consumers Energy is Michigan's largest energy provider, where a vulnerable population of approximately 10,000 individuals pay their utility bills in person each month with cash. The community navigator actively engages people in the lobby of the payment center so one or more of their needs can be addressed in one stop, in real time.
The community navigator has been well received by Consumers Energy customers who asked questions and got information while waiting in line to pay their bills. This led to a steady stream of people making navigation appointments. "By delivering community navigation services onsite, we can reduce service access barriers and create an environment that mitigates the impact of the social determinants of health that negatively affect the health of people in our community if not addressed," says Stephanie Duggan, MD, regional president and chief executive officer of Ascension Michigan's Mid/North Region.
The emPOWER Genesee community navigator has completed several certification programs that provide specialized training in connecting people with community assistance programs, services and resources. The community navigator is a certified community health worker through the Michigan Community Health Worker Alliance. The group provides training across eight core competencies: public health and health systems; legal and ethical responsibilities; navigating community resources; communication styles and cultural responsiveness; teaching and capacity building; coordination, documentation and reporting; healthy lifestyles; and behavioral health, substance use and abuse disorders. The community navigator is also a certified application navigator for the federal Health Insurance Marketplace; a Michigan Medicare/Medicaid Assistance Program counselor; and has specialized training to enroll people in the Michigan Medicaid MI Bridges program.
Even in the face of the coronavirus pandemic, the program safely provided virtual navigation services to Consumers Energy customers. It also expanded its reach through a computer kiosk at the Ascension Medical Group Genesys Downtown Flint Health Center, where patients with social determinant of health needs could access navigation services virtually and confidentially. The health center serves 2,100 patients annually, the majority of whom are Medicaid-insured and likely to experience challenges with social determinants of health.
In the spring of 2022, the Ascension Genesys Downtown Health Center transitioned from virtual to in-person navigation services where patients can now meet with the community navigator immediately following their medical appointments. In-person services at Consumers Energy's direct payment center have been scheduled to return this fall.
IMPACT ON COMMUNITIES SERVED
Since emPOWER Genesee's launch in October 2019, the community navigator has engaged with more than 1,300 unique clients, resulting in more than 4,000 service access calls to clients, health care providers, energy assistance personnel and community service providers. Of these clients, 945 received direct health care and energy assistance referrals, and 487 received community service referrals.
Overall, the most needed services are housing/shelter (35%); completion of State Emergency Relief applications (33%) that qualify individuals to receive energy assistance; daily essentials, including food, water and clothing (22%); and mental health, substance use treatment and health care (8%). In 2021 alone, 239 State Emergency Relief applications were completed, with 98% of applicants served by the navigator receiving financial assistance. An emPOWER Genesee client shared about her experience, "Anytime I have applied for State Emergency Relief assistance or the Consumers Affordable Resource for Energy Program, I have always been approved or gotten help in some way. I would 100% suggest the emPOWER Genesee Program to any family or friends who are in need of any kind of help."
The program often assists clients who do not have other resources to turn to for help, whether assisting a mother of six to restore her power and lower her monthly utility bills, to helping a recently released inmate enroll in Medicaid and food benefit coverage and obtain a free government-assisted mobile phone.
CONCLUSION
As a result of their collaboration, Ascension Genesys Hospital, Consumers Energy and Huntington Bank received Genesee Health Plan's 2021 Health Care Hall of Fame Community Partnership award for working with the health plan to ensure members receive quality, affordable health care. Genesee Health Plan President and CEO Jim Milanowski said, "This innovative approach is an excellent example of how public and private organizations are working together to meet people where they are with their health care, utility and financial needs."
Program representatives were also invited to the 2021 Root Cause Coalition's Annual National Summit to present emPOWER Genesee as a best practice model to address social determinants of health, and as an example of how public and private organizations are working together to meet people where they are to navigate complex systems to access essential services.
ANDREW KRUSE is director of community benefit for Ascension Michigan in Grand Blanc, Michigan. SUSAN TIPPETT is director of grant administration for Ascension Michigan Foundation.
NOTES
- "Social Determinants of Health: Know What Affects Health," Centers for Disease Control and Prevention, https://www.cdc.gov/socialdeterminants/index.htm.
- "Social Determinants of Health," U.S. Department of Health and Human Services, https://health.gov/healthypeople/priority-areas/social-determinants-health.