Health Care, the Whole Person, and Community Engagement

A Case Study of the Church Health Center of Memphis, TN

by Antony Sheehan, Maureen Bisognano and Robert Waller

This article is excerpted from Health Care, the Whole Person, and Community Engagement: Church Health Center of Memphis, Tennessee by Sheehan, A., Bisognano, M., Waller, R. Published by the Institute for Healthcare Improvement, Cambridge, Massachusetts, October 2014. The full article is available at www.ihi.org.

The Church Health Center in Memphis, Tennessee, is committed to encouraging healthy living as individuals and as communities. Life is experienced more fully when living involves individuals reaching their highest level of wellness in body and spirit. Health is more than the absence of disease, and health care is more than access to medical technology. Effective health care gives people tools to live healthy lives. The 27-year history of the Church Health Center in Memphis, Tennessee, demonstrates that it has long-embodied core principles rising out of current conversations about health care reform. As the US’s largest privately funded, faith-based health care organization, since 1987 the Center has expressed its vision under the broad categories of medical, wellness, and outreach. In 2014, a fourth category of knowledge, or thought leadership, was added to the organization’s structure.

Medical

The Church Health Center provides quality, affordable health care to the working uninsured of Memphis and Shelby County, Tennessee, and encourages healthy bodies and spirits for all. What began as a clinic serving 12 patients on its first day is now a primary care medical home to more than 61,000 patients. An urgent care walk-in clinic supplements the normal appointments of the main clinic. The Center has 1,000 volunteer medical professionals from every subspecialty, and partners with most hospitals, labs, and diagnostic centers in the area to provide services to a low-income and often underserved patient base … In addition to medical care, on-site services include dental care, optometry, counseling, social work, and nutrition and fitness education, all aimed at promoting wellness in every dimension of life. Consulting with the Church Health Center, Dr. David H. Ciscel, professor emeritus of economics at the University of Memphis, researched the economic value of the clinical care the Church Health Center provides compared to the cost of insurance coverage. In an unpublished study, he determined that for an individual, in 2012 a one dollar contribution or payment to the Church Health Center was leveraged to provide the equivalent of almost eight dollars in health services.

Founded by Rev. Scott Morris, MD, the Church Health Center had only been seeing patients for a few years when leaders recognized that not every patient eligible for services could come to the Center’s location; neither could every doctor who wished to volunteer his or her services. In 1991, the Center successfully petitioned the state legislature to enact a law allowing the organization to offer the MEMPHIS Plan, an employer-sponsored health program that extends care to thousands of Memphis residents who otherwise would not have access to affordable services. The Plan is a volunteer health care plan designed to serve uninsured workers whose earnings are near the minimum wage. Small businesses and the self-employed are eligible to participate in the MEMPHIS Plan. Employer and employee share premiums for a covered worker and dependents. Individuals enrolled in the Plan are assigned to primary care physicians who volunteer for the MEMPHIS Plan and see patients in their own practices. The Plan provides sick care and checkups; laboratory and diagnostic testing; dental and optometry; counseling sessions at the Church Health Center; fitness classes and health education; hospitalization for family members over 12 years of age; and prescription discounts.

The Church Health Center clinic partners with Methodist Le Bonheur Healthcare for hospitalization services in the MEMPHIS Plan. Over the years, multiple data files without common fields made it difficult to track Church Health Center utilization of the Methodist system. Recently, the Church Health Center migrated to an electronic medical records platform that enabled a data-matching process with the Methodist system. A Truven Analytics study compared hospitalizations of patients in the Church Health Center with a control group in a family practice unrelated to the Church Health Center that serves a similar vulnerable population. The results, from July 2008 to February 2011, demonstrate that the MEMPHIS Plan is effective at reducing hospitalizations, lengths of stay, and costs (Table 1).

Maureen Bisognano, at the Institute for Healthcare Improvement (IHI) 25th Annual National Forum, argued for “flipping health care.” One of the key points in this endeavor is to ask patients not “What is the matter with you?” but “What matters to you?” A person, not a disease, is at the center of improving health care.

Empowering the patient allows the Church Health Center, including the medical provider, to work together with the patient for optimal wellness, rather than giving the patient a set of rules to follow. Health coaching assists patients in understanding their disease, if they have one, and then helps them focus on how to make changes to put their goals into action.

Wellness

The Church Health Center created a model of health care that integrates wellness and medical care while addressing the spiritual needs of those it serves. A wellness mentality includes thinking beyond the illnesses doctors typically address in a clinical setting to other parts of physical and emotional health that undoubtedly affect an individual’s quality of life. From the beginning, the Church Health Center has focused not only on treating illness but also on helping people experience greater whole-person wellness.

The staff is committed to helping members make lasting changes to live healthier lives. In pursuit of this goal, staff of Church Health Center Wellness developed the Model for Healthy Living to help patients and members examine seven key areas of their lives and work toward a balance that will improve whole-life health. This foundational tool now is also used in the clinic setting and in publications of the Church Health Center.

Church Health Center Wellness is a supportive community helping members reach their highest level of wellness. Recent research on the effectiveness of the community-based approach at Wellness revealed improvements in the health, body, and spirit of study participants with obesity and diabetes … Participants were drawn from the Church Health Center’s clinic patient base to be part of a 12-month intervention study that included access to the Wellness facility, education, health coaches, dietitians, and exercise staff. A final 18-month interview and data collection point was used to assess the ongoing effect of the Healthy Living Program. Dr. SangNam Ahn at the University of Memphis School of Public Health analyzed final data. The study revealed successful reduction in biometrics, but it also showed significant improvement in a range of quality of life measures. Most notably, anxiety and depression dropped by 23 to 30 percent, and life satisfaction increased by nearly 20 percent.

In its 2014 report entitled Time to Act: Investing in the Health of Our Children and Communities, the Robert Wood Johnson Foundation included the recommendation to make investing in America’s youngest children a priority. Because education relates so consistently to the socioeconomic determinants of health and wellness over a lifespan, early childhood education is critical. The Church Health Center has long embraced this value. Although many traditional gyms offer drop-off childcare while members exercise, Church Health Center Wellness includes a range of structured curriculum-based activities for children and teens to help form a lifelong understanding of health. The Child Life Education and Movement program for children from six months to 11 years of age includes group games, physical activity, yoga, dance, nutrition lessons, cooking classes, and art workshops that encourage a child’s health, learning, and well-being.

Outreach

Another recommendation from the Robert Wood Johnson Foundation Commission to Build a Healthier America was to broaden health care to promote health outside the medical system. Just as priorities in Church Health Center’s Medical category integrate with activities in the Wellness category, the Wellness category priorities also integrate with those in the Outreach category. The conviction that changing the health of children begins in their earliest years and is consistently tied to education takes the Center’s work outside its own walls. For more than 15 years the Church Health Center has operated, in a public school, one of the highest-performing preschools in Memphis.

The Church Health Center also exemplifies the value of promoting health outside the medical system through sustained connections with 700 congregations in and around Memphis—and constantly seeks to reach more. Because of its commitment to promote health in spirit as well as in body, the Church Health Center has always engaged the faith community of the city it serves. Expanding services beyond clinical care was an opportunity to give patients the best possible approach to their health, and to invite individuals and groups to connect in a shared mission. The Church Health Center turned to the entire faith community—rich and poor, large and small, black and white, across denominations and faith traditions—with a message about the opportunity to heal. A Jewish synagogue was among the earliest financial donors to the work of the Center and continues in partnership today.

Reaching beyond the Memphis community, the Church Health Center produces an array of online and print resources. Church Health Reader began as an online magazine with frequent additions of new content for individuals and congregations looking for ways to engage with health ministry. Later, a quarterly print version became a practical tool to put into people’s hands. Various curricula, study guides, self-help, and devotional materials, available through the Church Health Center as well as local stores and online retailers, support a message of wellness and provide resources that may be adapted to a variety of settings.

In addition, the Church Health Center targets faith community nurses (FCNs) with the Perspectives newsletter and other support services for people on the front lines of engaging communities around themes of wellness. The Church Health Center also has undertaken a research project, which will include five hospital participant sites, to demonstrate the effectiveness of involving FCNs in transitional care to reduce hospitalizations and readmissions.

Knowledge

With innovative problem-solving, ever-expanding numbers of patients, and a burgeoning production of resources, the Church Health Center has emerged as a thought leader. The Center is in a unique position to share knowledge in the field of faith and health with lay people and clergy active in churches, large not-for-profit health care systems and faith-based clinics, and academic institutions providing formal education experiences that intersect with the field. The experience of the Church Health Center in serving the underserved may serve as a platform to help medical communities learn to serve this population more effectively. Through growing a knowledge network, the Church Health Center will be intentional about sharing its experience in a variety of ways with hospital systems and clinics, while remaining rooted in a successful faith-based model for meeting needs and engaging the community.

The Church Health Center is now the organizing host of the annual Westberg Symposium for faith community nurses and others involved in health ministries. Other events include clergy conferences and workshops for groups interested in learning from the Church Health Center’s model of being a primary care medical home that addresses wellness in body and spirit, with a view to replicating the Center’s model in other cities. As the Center’s knowledge sharing strategy takes shape, the number of events and venues will expand, multiplying opportunities for individuals and organizations to expand their learning in faith and health, in service of the underserved.

Integrating Health Care into Shared Community Life

For all of its history, the Church Health Center has valued city-wide collaborations. The organization’s goal is not only the success of the Church Health Center, but also the success of the wider community in improving the health of all of its citizens. To that end, the Center works on innovative collaborations, serving as a sort of laboratory for life-giving practices that move past current barriers toward new ways of working together with governments, health care systems, and community initiatives.

The third of three major recommendations from the Robert Wood Johnson Foundation report is to create communities that foster health-promoting behaviors, and the Church Health Center is now on the brink of its most complex collaboration to date that moves toward this ambitious goal. The Center is part of a coalition of business and community leaders redeveloping a massive vacant structure that once housed a Sears catalog order distribution center. Rather than being torn down, the building will be transformed into a thriving “vertical urban village” focused on health care, education, and the arts that will enliven the neighborhoods surrounding it.

Dr. Donald Berwick, founder and president emeritus of the Institute for Healthcare Improvement (IHI), has been talking for several years about a “wedge” model of reducing waste by targeting six broad areas in the health care system. Led by Dr. Scott Morris, founder and CEO, the Church Health Center has used a “wedge” model for providing effective, affordable health care to the underserved. The Center’s wedges are the power of community; the MEMPHIS Plan; the Model for Healthy Living; the community of Church Health Center Wellness; and the mobilization of the faith community.

The US president, Congress, and the courts simply cannot design how health care is delivered from a central location. Only the local community can respond to the unique combination of factors present in its location. As Dr. Robert Waller, former CEO of Mayo Clinic, points out, the US can spend more on health care, which hardly seems possible; or it can help less, which is unconscionable. Or, it can redesign health care by turning to the power of the community to redefine health care and pursue true health. Under the continuous visionary leadership of Dr. Morris since 1987, the Church Health Center is one of a very few organizations successfully embodying all three components of the IHI Triple Aim by improving population health outcomes, enhancing the individual’s experience of health care, and reducing or controlling costs. All three have been part of the Center’s DNA since its inception, and as a transforming force in the community, the model is well worth the attention of health care professionals around the country.

References:

Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012;307(14):1513-1516.

Bisognano M. “Flipping Health Care.” Presentation at the IHI 25th National Forum, December 2013 in Orlando, Florida. http:www.youtube.com/watch?v=ATaEgJsidJo.

IHI Triple Aim Initiative. http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx.

Time to Act: Investing in the Health of Our Children and Communities. Recommendations from the Robert Wood Johnson Foundation Commission to Build a Healthier America. 2014.

Waller R. Interview remarks on receiving the 2011 American Ophthalmological Society Howe Medal. http//www.youtube.com/watch?v=WYi9mUdgcOk.

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