The Donald Effect in Healthcare

The following is an excerpt from Navigant Healthcare’s Pulse Weekly. Click here for a complete copy of this week's article. 

No one knows how Donald Trump’s meteoric rise to the top of the GOP primary race ends, its impact on Campaign 2016 or its domestic and foreign policy implications for the U.S. will play out. What we know is the man knows how to get a crowd, spark discussion, and steal media attention from his 16 GOP primary rivals. He has built his brand as a straight shooter on tough issues and unapologetic foil of political correctness.

Friday night, the Donald show flew into Mobile, AL, and lit up a crowd estimated at 20,000 at the University of South Alabama football stadium. He left town on Trump Air dominating the weekend’s media coverage, perplexing the pundits who were betting the Donald show would flame out.

Political theatre is prone to big stories like “the Donald”. He’s brash, cocky and unfiltered as he talks about dicey issues. He has simple solutions to immigration reform and the threat of ISIS. He promises to be a tough commander in chief in war zones and fierce negotiator in trade pacts. Healthcare is on his list as well.

Friday night, he promised to “repeal and replace” the Affordable Care Act. He called out insurers:  “The biggest beneficiaries of Obamacare are the insurance companies… the insurance companies love it. They are so protected; they are making a fortune. We are going to end that – we are going to get so competitive by getting rid of the artificial barriers…Just take a look at your premiums, your deductibles – they’re so high it’s impossible.” He’s on record saying the U.S. health system is the best in the world, needs less government intrusion and more free market-driven reform. End of story. Then he moved on to other issues and pitched his book, The Art of the Deal, unashamed. His teleprompter-less straight talk and the stadium fly-over by Trump Air reflect the uncanny showmanship the Donald is bringing to Campaign 2016.

But what if he had spent more time on healthcare Friday night? What if he had zeroed in on healthcare in Mobile? It’s a market where big players dominate and consumer choice is limited. There’s one major plan – Blue Cross of Alabama, and two major health systems, Providence and Mobile Infirmary. Utilization is high, health status is poor, and premiums are above the state’s average and going up.

In vintage Trump-speak, he might have said “You’re stupid. You’re the problem: You are not very healthy and it’s costing you. And your community isn’t doing anything to fix it. That’s why your premiums are going up. That’s why you have more doctors and beds than you need. You’re the problem..”

Might those cheers suddenly become jeers? Probably.

The fact is that communities like Mobile are more the rule than exception. Data show that a community’s health– how its employers, payers, community leaders and providers address the healthiness of their citizens– is key to lower costs and better health. With due deference to efforts like accountable care organizations, bundled payments, and shared risk arrangements with payers, it takes a community to reform healthcare.

So if Mobile’s a stage for fixing healthcare, the issue of community health must be on the table. In some communities, these efforts are underway; in most communities, these efforts are modest if at all.

Even the Donald might be challenged to bring straight talk to healthcare. And straight talk about healthcare requires serious talk about the community’s role. That could be the Donald effect.

Paul

Sources: Donald Trump Campaign Rally in Mobile, Alabama, C-SPAN, August 21, 2015; Dan Diamond, “Donald Trump Hates Obamacare – So I Asked Him How He’d Replace It,” Forbes Business, July 31, 2015

Key statistics about healthcare in Mobile, AL

Resources:

Socio-Economic Determinants of Community Health

Landmark Study Reveals Connection between Workforce Health and Community Health: Research details how businesses benefit by investing in community health.

Factors that impact community health: Geographic location; neighborhood socioeconomic status

A study conducted by the Vitality Institute and supported by the Robert Wood Johnson Foundation (RWJF) finds that the health of the workforce is linked to the overall health of the community in which it is located. Understanding this connection may help businesses improve workforce productivity and reduce health care costs.

Community Health as a Goal of Good Design

Factors that impact community health: Regional location, access to transit and population density

This article provides evidence and rationale for land use policy change – presents a brief summary of existing research, categorized by built environment issue. It is intended to help planners work with public health practitioners toward land use policy solutions that improve community health.

Community Health Centers Leveraging the Social Determinants of Health

Factors that impact community health: Development of Community Health Centers

There are important opportunities for health care to increase its impact on health and wellbeing by leveraging the “social determinants of health” (SDH) – the social, economic, and physical conditions that underlie and shape health. Based on a review of community health center (CHC) efforts in this domain, this report offers leaders in CHCs, public health, and policy an understanding of how health care providers can move beyond health care services alone to improve the health of the entire population.

“Where We Live Matters for Our Health: Neighborhoods and Health”

Factors that impact community health: Geographic location; neighborhood socioeconomic status

The physical, social and service environments of neighborhoods can promote health or put health in jeopardy.

  • The physical environment includes the “built environment”— the environment resulting from structures built by humans—as well as the natural environment.
  • The social environment includes the quality of relationships—such as trust, connectedness and cooperation—among neighborhood residents.
  • The service environment includes neighborhood resources for education, employment, transportation, health care, grocery shopping, recreation and other services directly or indirectly tied to health.

“Exploring the correlations between health and community socioeconomic status in Chicago”

Factors that impact community health: Socioeconomic disadvantage

The author uses community level data available through the City of Chicago Data Portal, as well as aggregated census tract level economic data compiled by the Federal Reserve Bank of Chicago, this article explores community-level SES conditions and corresponding health outcomes in Chicago’s 77 communities to derive a localized perspective on a commonly accepted hypothesis that the socioeconomic conditions of places contribute to the health outcomes of residents.

“The influence of neighborhood-level socioeconomic deprivation on cardiovascular disease mortality in older age: Longitudinal multilevel analyses from a cohort of older British men”

Factors that impact community health: Poverty; social isolation

Neighborhood-level socio-economic deprivation was associated with an increased risk of cardiovascular disease mortality in neighborhoods of elder people.

Illustrative Community Health Projects

Health Ontario Initiative Ontario, CA

Toward a Healthy Sustainable Food System Pasadena, Texas

Engaging the Community in New Approaches to Healthy Housing Cleveland, OH

Healthy Homes East Bank Des Moines, IA

Build Health Challenge Los Angeles, CA

Project Access Colorado Springs, CO

The Healthy Hill Initiative of Springfield Denver, CO

Chandler Park healthy neighborhood program nets $75,000 Detroit, MI

Partners in Seattle’s Chinatown-International District receive national grant award for health and housing innovation Seattle, WA

The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.

©2015 Navigant Consulting, Inc.