By Les Gura

Like providers nationally, California-based Dignity Health has adapted its care delivery system to adjust to the requirements of the Affordable Care Act.

But Dignity Health has done so with an innovative and diverse array of programs spread across its 40 hospitals in California, Arizona and Nevada. The non-profit, with 60,000 caregivers and staff members, is the fifth-largest health care system in the nation.

Addressing the social drivers of health

Pablo Bravo, Dignity’s vice president of community health, says the expansion of outreach programs was important to reach underserved populations.

“With the passage of the Affordable Care Act, the whole industry is really looking at population health management,’’ Bravo says. “That being the goal, what we want to do outside in the community is really create the support of structures—or support other structures already in place—to be able to address these issues in the community before individuals land in the hospital or go to a doctor and get bad news.

“And we want to be able to address these issues with our partners in the community.”

Dignity Health’s multifaceted approach to improving population health includes:

• Loans made at below-market interest rates to non-profits working to improve health and quality of life in the community.
• Grant programs addressing community health needs collaboratively with non-profits.
• Programs that promote sustainability and a healthy environment.
• Co-sponsoring a Learning and Outreach Center in Bakersfield, California, that touches the needs of hundreds of families with programs for children, families in need and the elderly.

“The ultimate goal is really to address health issues identified in communities through Community Health Needs Assessments,’’ Bravo says. “Issues such as asthma and chronic disease, homelessness. We try to target resources to those populations, and use ‘hotspotting,’ which can track people in certain ZIP codes.”

Investing in social innovation

One example of Dignity Health’s work to reach underserved populations is a new social innovations grant program. Dignity Health offered a total of $700,000 in grants to organizations that proposed innovative ways to address health.

Meredith Barrett is vice president of science and research for Propeller Health, a company that has developed a device to improve management of respiratory disease.

The company puts a sensor on asthma inhalers that can track adherence to use of inhalers by individuals. The goal is to give care providers information about when people are struggling with asthma so they can be assisted before a crisis lands them in an emergency department.

“It’s a small little cap that fits on top of a dose inhaler,’’ she says. “We’re able to passively and objectively track where and when people are using their medications.’’

Propeller Health already has completed a randomized study with Dignity Health’s support in Sacramento and Woodland, California, two areas where a large number of people suffer from asthma. Now, a social innovation grant from Dignity Health is helping pay for a new study in Bakersfield that is targeted toward tracking inhaler use among children and adolescents.

“Dignity has been a leader in the field of how to incorporate technology,’’ Barrett says. “They’re interested in addressing environmental exposures and serving underserved populations, so they’ve been a really great partner.”

Looking upstream

Bravo says Dignity will continue to seek out projects that can address big-picture health concerns, especially among the underserved.

“We funded a project in the Central Valley (of California) to address water purification; the drought has caused a lot of issues with access to clean water. We funded a project that addresses the high use of the emergency department by the homeless.

“We’re identifying populations and trying to steer our programs to them,’’ Bravo says. “The idea is we’re looking upstream and seeing what’s triggering health issues so we can possibly make a change.’’