University of New Mexico Hospital - Health Commons

Overview

University of New Mexico (UNM) Hospital, a 384-bed acute, tertiary care facility, is the primary teaching hospital for the UNM Health Sciences Center School of Medicine and is home of UNM Children’s Hospital. UNM Hospital is located within the University of New Mexico Health Sciences Center in Albuquerque. The Health Sciences Center includes, in addition to UNM Hospital and UNM Children’s Hospital, the School of Medicine, College of Pharmacy, College of Nursing, Cancer Research and Treatment Center, Children’s Psychiatric Center, Carrie Tingley Hospital, UNM Psychiatric Center and the Health Sciences Center Library.

UNM Hospital leaders recognized that intractable health problems such as higher rates of illness among the poor and uninsured have their roots in social and economic determinants that cannot be adequately addressed by the health care system alone. They also realized that an integrated partnership with other sectors of society was crucial to effectively serving their diverse communities. With funding from the W.K. Kellogg Foundation and the Health Resources and Services Administration’s (HRSA’s) Community Access Program (CAP), the Health Commons concept was developed by the University of New Mexico Department of Family and Community Medicine in collaboration with its safety net stakeholders.

New Mexico’s Health Commons models include the following defining characteristics:

• Promoting universal access to primary care homes as a public health measure
• Creating a one-stop, seamless system providing medical, behavioral, dental, and social services that offers advanced case management, information systems, and links to community resources through community health workers
• Expanding the training of community-based, interdisciplinary health professionals in needy communities
• Developing pipelines to build a diverse work-force of health professionals
• Ensuring the Health Commons becomes a source of local employment and economic development

Initially, four unique Health Commons models were created for two urban communities and two rural communities. The four Health Commons were supported by the Central New Mexico CAP and the Department. The Department’s initial CAP collaborators included federally qualified health centers, the Indian Health Service, an urban Indian health clinic, a homeless clinic, rural clinical services, and the New Mexico Health Department. The group later expanded to include behavioral and oral health and social service agencies.

Impact

Integrating primary care and oral, behavioral, and social services allows each member organization to better serve its clientele. Duplication is decreased, visit time is reduced, no-show rates drop, and use of clinician time is maximized. Further, each Health Commons serves as an economic development zone, helping to break the poverty cycle in indigent communities. Additional models currently are being launched.

Challenges/success factors

Important lessons have been learned from New Mexico’s Health Commons sites:

• Community wisdom – Priorities at each Health Commons were guided by partner and community input. Usually, the indigent and uninsured have little control over important decisions affecting their health. Yet their frontline experiences with the often harsh health system trigger creative approaches to problem solving. For example, in the Southeast Heights Health Commons, two family medicine residents explored options for a community-based health improvement project with unemployed Hispanic women enrolled in the clinic. To the residents’ surprise, the women’s “health” priority was finding employment; therefore, the women created the La Mesa Cleaning Cooperative. The residents came to believe that economic development was a legitimate and effective health intervention addressing the social determinants of illness presenting at their clinic.
• One-stop shopping – Integrating primary care and oral, behavioral, and social services allows each member organization to better serve its clientele. Integration creates programmatic and fiscal efficiencies. Duplication is decreased, visit time is reduced, no-show rates drop, the time required to make referrals decreases, and the efficient use of expensive clinician time is maximized.
• Information systems and information technology – In a rural, poor state, access to and quality of medical care are enhanced through accessible electronic health information systems. Creating methods to quickly route unassigned emergency department (ED) patients to a primary care home can increase use of preventive services and reduce unnecessary ED visits and hospitalizations.
• Collaboration instead of competition – Collaboration among formerly competing organizations led to unimagined innovations, attracting new private and public funding. Health Commons are appealing to funding agencies and investors and can redirect existing resources to address individual and community health needs even in the poorest, most remote locations.
• Superior service-learning model – The Health Commons are the most popular clinical training sites for medical students and family medicine residents, who often become role models for local youth at risk of dropping out of school. Resident graduates prefer these sites for practice. These models double or triple the rate of retention of graduates who practice in underserved sites.
• Sustained funding – The investment in building the Health Commons sites and service, initiated with $2 million in federal funds (from HRSA’s CAP) over four years, led to products that are highly attractive to public and private funders. Federal, state, and county funds supported construction of the $10 million South Valley and the $1.2 million Sandoval County model Health Commons sites. State and MCO funding of $1.7 million supported development and implementation of the statewide Health Advice Line. In addition, an MCO contributed $140,000 to hire Health Commons community health workers to find “missing” high-risk Medicaid enrollees.

Future direction/sustainability

The success of the Health Commons approach has been one element in encouraging the UNM Health Sciences Center’s executive vice president/dean and the institutional leadership to engage in a statewide initiative in which the AHC will partner with community groups to achieve the greatest improvement in health status of any state in the nation. Key features will include replication of Health Commons models in different areas of the state and establishment of AHC-linked, community-run Cooperative Health Extension Offices to facilitate access by communities to needed AHC resources in education, service, research, and policy. The offices will be modeled on the agricultural cooperative extensions. In addition, a Community Health Report Card will be developed to measure the impact of the above interventions.

Advice to others

The creation of community partnerships can facilitate a more orderly distribution of indigent patients within the community and a more predictable use of resources. Broad stakeholder participation built trust and investment in the Health Commons, expanding services for the uninsured. This participation also fostered marketable innovations applicable to all Health Commons’ sites. Family medicine can promote the Health Commons as a venue for linking complementary strengths of the academic health center and the community, while addressing the unique needs of each. UNM’s experience suggests that family medicine can play a leadership role in building collaborative approaches to seemingly intractable health problems among the uninsured, benefiting not only the community but also the academic health center.

Contact: Cindy Foster
Senior Public Affairs Representative
Telephone: 505-272-0260
E-mail: cindyf@salud.unm.edu