University Hospitals Receives Robert Wood Johnson Foundation Grant to Research 'Web of Well-Being'
February 25, 2021
CLEVELAND – The Robert Wood Johnson Foundation (RWJF) has awarded University Hospitals (UH) a $300,000 grant to research a new UH-developed model that is designed to help patients with their physical and mental health, and social needs by teaming them up with case managers who will develop a long-term, relationship-based approach for vulnerable patients on Medicaid.
UH is one of nine organizations in the U.S. that received a RWJF grant that sought proposals for promoting health equity in the Medicaid population. RWJF’s research agenda is seeking comprehensive approaches that transform health systems and promote health equity.
Patrick Runnels, MD, Chief Medical Officer of Population Health and Behavioral Health at UH, Vice Chair of Psychiatry at Case Western Reserve University, and principal investigator of the study, said the grant will help determine if this new type of model could help Medicaid patients better handle a range of complex issues in their lives.
“These patients have multiple, complex issues that are difficult for the individual to solve, or in some cases, patients themselves don’t believe in their own ability to solve them, so they don’t engage,” said Dr. Runnels. “In addition, some don’t believe the system can help them because they have no trust in it.”
Nearly 170,000 patients in UH’s accountable care organization (ACO) are on Medicaid. Nearly all of them have at least one area of severe social or economic distress.
The study began in January and will collect data through June 2022. Data analysis will be complete by August 2022 at which point the conclusions will be submitted to RWJF.
Dr. Runnels explained that the traditional case management method is flawed because it tries to solve for only one issue at a time.
“Case management traditionally seeks to connect individuals with targeted solutions to specific problems, and will close the case when that resource has been provided, as opposed to seeing the totality of an individual’s issues and working with that patient over the months or even years that it sometimes takes to unravel all the complexity,” said Dr. Runnels.
He said experts in the mental health field have known for decades that a successful approach for helping patients seeks to develop a long-term relationship with the patient that first seeks to build trust in the system, then seeks to help someone build confidence in themselves, before helping them and partnering with them to build the ability to apply solutions and solve problems in their lives.
“When we look at this work with people who have severe mental illness, we know that it actually goes a long way to improving their health outcomes and reducing their health utilizations. We believe this can apply to a larger population of patients, and can actually improve equity and outcomes,” he said. “We call this program the Web of Well-Being (WoWB) with Integrated Clinical Case Management.
“When you have a lot of barriers that are just aggregated together, you just can’t give people one-off solutions to a specific problem. For example, if you are a single parent, and you have trouble with child care, and you don’t have transportation, and you have food insecurity, and I give you a voucher for a bus, I haven’t solved your problem for childcare in order for you to get to your healthcare appointment. I can’t just give you a voucher for daycare, if you don’t have transportation. And when you add to it people who have experienced severe childhood trauma, giving them a voucher for a bus or a cab, means they have to get into a public space that can be scary or overwhelming to them.
“In order to make a real impact, you actually have to spend time finding ways to start to blend solutions together taking care of all the barriers at once.”
UH’s new program is designed to have case managers build relationships with each person assigned to their care by devoting several hours a month to each individual. Each UH case manager will have no more than 30 people in their caseload at any given time and will care for these individuals over the course of months and possibly even years and will respond to a person’s needs in real time as they arise.
Case managers will be a mix of nurses, professional counselors, and social workers who will meet the patients in their homes and, for example, take them to the social security office to sign up for disability, or take them to the primary care appointments and sit with them in the appointment to help them understand treatment recommendations, or help work with them on what they need to do to take care of their health problems, or help them figure out how to manage their utilities, or how to organize their diet, and shop and cook if that’s what’s needed.
“This program is unique because it makes the relationship with the patient as the focus from which everything else flows,” explained Peter Pronovost, MD, PhD, Chief Quality & Transformation Officer at UH and co-principal investigator of the RWJF study.
“You have to start from a place of love. Love provides empathy for all, recognizing that the vast majority of people just want to be loved. With this program, we aim to help our patients feel connected and cared for. We know that means sometimes working through the bitterness, and the anxiety, and the anger that comes from having fallen through the cracks for so long. But we have to start somewhere. Change progresses at the speed of trust.
“The grant builds upon and extends our prior efforts to improve population health to focus on the most vulnerable. No doubt what we learn here will extend to others,” said Dr. Pronovost.
We will also determine if this type of approach will have success in keeping people healthy at home, and eliminating defects in value for the patient, and therefore reduce the overall cost of care for each patient,” Dr. Runnels concluded.