A Portfolio of Community Investment With Advocate Health

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Tom Haederle
Hospitals and health systems are rightly called cornerstones of their communities. And as nearly 6 million patients spread across six states can attest, few care providers take that mission more seriously than Advocate Health. Headquartered in Charlotte, North Carolina, Advocate is the third largest nonprofit health system in the nation and takes pride in serving a large number of under-resourced patients.

00;00;22;12 - 00;00;40;14
Tom Haederle
Name a want or a need or a gap in community services, and chances are Advocate Health is already working with local partners to address it.

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Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. According to Dr. Kinneil Coltman, chief community and social impact officer, Advocate Health provided nearly $6 billion in community benefits in 2022. The funds supported a wide variety of programs and initiatives as leaders spent a lot of time thinking about where do we focus?

00;01;05;12 - 00;01;21;24
Tom Haederle
In this podcast hosted by Aaron Wesolowski vice president of Policy, Research, Analytics and Strategy with AHA, Coltman says certain priorities leapt to the top. They included addressing food insecurity, affordable housing and a meaningful employment.

00;01;21;26 - 00;01;31;13
Aaron Wesolowski
Dr. Coltman thanks so much for joining us. We're so excited to be talking today. Can you start by telling us a little bit about Advocate health and the patients and communities that you serve?

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Kinneil Coltman
Advocate Health is the third largest nonprofit health system in the nation. We serve a diverse array of patients, nearly 6 million unique patients across six states: Alabama, Georgia, Illinois, North Carolina, South Carolina and Wisconsin. Many of our hospitals serve as the primary safety nets in their communities, so we serve a large number of under-resourced patients.

00;02;00;04 - 00;02;19;24
Kinneil Coltman
We're the number one Medicaid provider, for example, in Illinois and North Carolina by volume. But throughout our footprint, we also care for patients in about 68 rural counties, and that's about 3 million residents. So we're really proud of the work that we do around solving for underserved communities needs.

00;02;19;26 - 00;02;25;28
Aaron Wesolowski
Great. How does advocate think about community benefit across the system and across all those hospitals?

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Kinneil Coltman
When I think about community benefit, I think about what are we doing that is truly benefiting society? We've noticed that sometimes those conversations may focus on one aspect of our community benefit, but we really look at it holistically. The pandemic really shined a light on the absolute necessity for us to focus on working even further upstream than maybe we would have in the past to really focus on disrupting those root causes of health inequities in our communities.

00;02;57;24 - 00;03;21;10
Kinneil Coltman
For us, we spent a lot of time thinking about where do we focus? so that we're going to have the deepest and most meaningful impact. And for us, we've kind of drawn a line in the sand around food insecurity, affordable housing and employment. When I say that, I mean meaningful employment, good wages, the provision of health insurance, career and economic mobility.

00;03;21;17 - 00;03;46;16
Kinneil Coltman
So that's where we focus our energies, both in terms of the programs we develop internally, but also in how we invest in the community. But all in and in 2022, we we had nearly 6 billion in community benefit, and that includes free care for low income patients, but also the cost of educating the next generation of health care workers and research.

00;03;46;16 - 00;04;15;07
Kinneil Coltman
We have a huge research enterprise that extends across our footprint, but also investing in those safety net organizations that we know are really serving those that need it most in our community. We've invested in things like a medical clinic in an HBCU in Charlotte for really novel solutions like virtual care in community centers. And we have countless food pharmacies across our footprint.

00;04;15;07 - 00;04;21;10
Kinneil Coltman
So it manifests in a variety of ways, but all in service to disrupting those root causes of health inequities.

00;04;21;12 - 00;04;38;15
Aaron Wesolowski
That's really impressive and really exciting to hear, and I want to hear more about it. Before we go deeper into Advocate Health and all the good that that you all are doing, I'm curious to hear a little bit more about you and your career. How did you get into health care and how did you find yourself in the role that you're in now?

00;04;38;17 - 00;05;07;17
Kinneil Coltman
Yeah, so I actually grew up in a rural area myself. I grew up in the mountains of western North Carolina. I had some really profound experiences in high school and in undergrad that led me down this path of wanting to work on kind of institutionalized systems of inequality. And so that's what I've devoted my career to, is really helping to architect health equity strategies in large complex health systems.

00;05;07;17 - 00;05;26;22
Kinneil Coltman
And for me, it's very personal. I still have a lot of family members that live in very rural areas that have a lot of challenges around transportation and other social drivers of health. So I, I think a lot about the folks that I grew up with when I think about the energies that I bring to my work every day.

00;05;26;24 - 00;05;39;19
Aaron Wesolowski
Well, thank you for sharing that. What trends have your hospital seen in recent years in terms of patient and community needs? And how has that changed Advocate's focus on providing care beyond the four walls of the hospital.

00;05;39;22 - 00;06;10;03
Kinneil Coltman
You know, I think it all boils down to meeting people where they are and getting to them before they need us, right? That's the goal. And so a lot of our conversations with our leadership are around modernizing access. We know the access to care is is a dramatic issue that impacts health across the country. So we've tried to think about really creative ways to reduce that friction to access care and to make it easier for folks, no matter where they live, to be able to access care.

00;06;10;06 - 00;06;37;18
Kinneil Coltman
So thinking about things like our virtual strategy. If there are gifts around COVID, that is absolutely been one. It's helped us to kind of broaden our aperture around thinking about where and how we can use virtual care in the future. So we, for example, have made huge investments and had other investments from partners in school-based primary care and behavioral health in schools.

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Kinneil Coltman
We are in 213 schools and that number grows every time I share that in 11 counties. And, you know, had just in the last year 26,000 patient visits with those. And we've been able to show that we can have a 32% reduction in E.R. visits once we create those kinds of interventions. We've also embedded virtual clinics in low income, affordable housing communities, in immigrant service centers.

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Kinneil Coltman
We're thinking about all kinds of places where we can deploy these interventions in new and different ways. We also see it a lot of promise around the management of chronic disease. We've stood up virtual chronic care management programs for patients that have those tough chronic diseases to manage, like diabetes, for example. So enrolling patients in those programs, knowing that they don't have to access transportation and deal with some of the other friction of accessing care that they can access, that support virtually is a big deal.

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Kinneil Coltman
And then the last one that I'll mention is our signature hospital home program, which we stood up virtually overnight during COVID. But since then we've been able to care for hundreds of patients at a time from the comfort of their home. And if you think about it, no matter how good of a job we think we do around care, our hospitals, people would always rather be in their homes than in a hospital.

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Kinneil Coltman
And so we've been able to deliver hospital level care inside the comfort of someone's home. So we're still working on those solutions, but we are giving it all we've got because we know that our patients and communities are depending on us to kind of pass those traditional access points that we've relied on historically in health care.

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Aaron Wesolowski
That's great. And I imagine that a lot of those local partnerships help you anticipate new needs that might be coming down the road at you as well.

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Kinneil Coltman
Yeah, absolutely. So we've seen, for example, we obviously have a large footprint in Chicago, and Chicago has had, you know, a surge in immigrants and in recent months. And so trying to figure out how can we be part of the solution of delivering care in unique and different ways. But we're seeing that opportunity across our footprint to listen more deeply to our communities and say, where do you want to get care?

00;09;03;02 - 00;09;17;05
Kinneil Coltman
How do you want to get care? When do you want to get care? And then we have a wonderful strategy team that's guiding us to think about innovative solutions in terms of how we deliver that care differently than we have in the past.

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Aaron Wesolowski
Stepping back, can you tell us why Advocate is committed to providing these services that that clearly extend beyond traditional medical care? Why is it important to impact health and well-being before someone even becomes a patient in a facility?

00;09;31;13 - 00;09;59;05
Kinneil Coltman
I think the answer to that question is, you know, a five-minute conversation with any emergency medicine provider that I've ever worked with, and I'm sure you have as well heard these stories that you think about in our emergency rooms. You may have someone who's unhoused and they may come two and three times a week sometimes. But as soon as that person secures housing, then we see their use of emergency rooms change for the better.

00;09;59;05 - 00;10;34;16
Kinneil Coltman
Right? And so you have all these stories that our providers collect and tell us about. And I think that creates a sense of urgency for us to be able to work further upstream, try to prevent that unhoused situation in the first place, try to get at those root causes that led to that incident of homelessness. So those are the things that we're thinking about all the time, that we've got to constantly work upstream because, you know, we have level one trauma trauma center  hospitals in so many communities that are in need.

00;10;34;19 - 00;10;53;27
Kinneil Coltman
We are the safety net. When all of the other safety nets break down, we see - we're at the very end of the line. So we see when all the other social systems fail, we're there to catch patients and community members when they need us so that that creates a burning platform, I think, to work upstream and be part of the solution.

00;10;54;00 - 00;11;16;09
Aaron Wesolowski
Building on that topic of of access, you know, ensuring that that all community members have access to care also means working to make care more affordable and make sure that patients have options around financial assistance. Can you talk about your work to improve financial assistance and the process around accessing it? And why is it important for families and patients?

00;11;16;12 - 00;11;40;01
Kinneil Coltman
So I mean, we talk about that all the time. In fact, when Atrium Health and Advocate Aurora Health came together just over a year ago, that was one of our big commitments was around affordability. And we already, in both legacy systems, had a lot of strengths, but we tried to, you know, curate the best of what each legacy system had in terms of building.

00;11;40;04 - 00;12;05;06
Kinneil Coltman
What I would argue is one of the most comprehensive and patient centered financial assistance programs in the country, because you hear a lot of discussions about federal poverty levels. And then, of course, we've committed to a very generous level of 300% federal poverty level gets full financial assistance, full charity care, and then up to 400% very, very deep discounted care.

00;12;05;08 - 00;12;28;22
Kinneil Coltman
You know, the devil's in the details on some of this stuff, that it's how we administer our program that I think is really meaningful for patients. So when you think about our patients who are under resourced and what may be going on in their lives, maybe working two and three jobs, we've really thought critically about how can we reduce the friction involved in qualifying for our financial assistance programs.

00;12;28;22 - 00;12;53;02
Kinneil Coltman
And so we have invested in a pre-qualification service that's really effortless, seamless to our patients. So I'm really proud of the way that we're working to reduce friction for patients and being able to access our policies. We also provide financial assistance for care that we know patients need. So it's not just for emergency care, but it's also for other essential care, primary care, behavioral health care.

00;12;53;02 - 00;13;14;17
Kinneil Coltman
So those are the things that we focused on. There's a lot of other players in the industry providers, insurers, drugmakers, pharmacy benefit managers. I can go on and on...that together, we need to solve for the affordability challenges in health care. We're committed to being part of that coalition that solves for this together.

00;13;14;20 - 00;13;26;04
Aaron Wesolowski
Absolutely. And that's that's great to hear. Last, what are you most hopeful about in health care? And are there things that you're really excited about in terms of innovations or patient programs that Advocate Health has planned?

00;13;26;06 - 00;14;12;26
Kinneil Coltman
There's so many big challenges ahead of us as an American health care system, right? But I'm also encouraged about what we can accomplish when we really focus. COVID taught us how much we can accomplish if we really focus on something. So for our part, over the last year, we've been standing at the Advocate National Center for Health Equity, and that's a really bold and ambitious strategy because it involves a national operating model that then will manifest interventions in all of our major service areas in different ways based on what the community tells us it needs, but also based on what we know from a public health data standpoint, is also necessary to improve health.

00;14;12;26 - 00;14;53;04
Kinneil Coltman
And so we are working on a very robust health equity analytics platform that will help us think differently about how we bring data to providers to intervene, but making sure that we have good clean data across our 6 million patients, but then also developing a framework of health equity interventions in our clinical environment. Soup to nuts. Every service line is then, you know, we have board approved health equity goals that we're cascading throughout the enterprise, but we're also looking at architecting national partnerships around those social drivers of health.

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Kinneil Coltman
But with all of our interventions, we have committed to studying them academically, right. In an academically rigorous way so that we can develop proof points, that we can educate other health systems that want to do this work, but also policymakers, elected officials on what are the solutions of the future around health equity, because we've got to have partnerships and a coalition to solve for these entrenched inequities together.

00;15;19;25 - 00;15;32;21
Kinneil Coltman
So I'm excited about that. You know, we're still in building mode, but I'm encouraged that we have a very ambitious board behind us that's very motivated around our health equity goals and ambitions.

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Aaron Wesolowski
Great. Well, thank you for sharing that. It's really heartening to hear all that you all are doing and the scale of the benefits that you're offering the communities you serve. And so thank you for sharing it. Thank you for being with us today.

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Kinneil Coltman
Yeah, my pleasure. Thanks very much.