The Memphis Model
Rev. Bobby Baker is the Director of Faith and Community Partnerships at Methodist Le Bonheur Healthcare in Memphis. He was interviewed by Tom Peterson in February 2013. Scroll to the bottom for links to articles on the CHN in The New York Times, Salon, Jama and others.
How did the Congregational Health Network get started, and how did you get involved?
I was serving as a chaplain at Methodist South, which is Methodist Healthcare’s community hospital in the White Haven area of Memphis. At that time, the administrator there, Joe Web, had a serious interest in the health of the community. He recognized that heath care resources were dwindling and began to look at how to maintain our viability in that community. First, the health of the community had to improve; if it didn’t, the hospital would not be able to care for the needs of the people we were serving. We were seeing people with advanced disease stages in their early twenties, such as end stage renal failure, people with cardiac issues that far exceeded their age. If you look into the future—which we’re now living into—at a population with those kinds of health issues, you see a chronic disease epidemic.
Methodist South serves an inner-city population with many disparities, so for the hospital to remain viable, we had to look at keeping people healthy as long as possible, keep people out of the hospital. This was before the health care act was proposed.
Joe decided first to create a network to get health education into the community. He was deacon and understood the power of the church in the African American community. So he began to reach out to pastors in that community. Besides being the chaplain there I was also a community pastor. Since pastors relate to pastors, I had a circle of friends I could reach out to. We agreed to begin working on a network of congregations through which we could better educate the community.
Some ask, “Why churches?” Some research that found that about 70 percent of the people we see in our emergency rooms say they have been in a house of worship in the last 30 days. We believe that is also true for our inpatient population. So if want to be in our patients’ lives outside the hospital, before they come in and after they leave, the congregation is where we’re going to find them.
So you began to gather a group of local pastors?
We got a group together, and we began by asking them to help us figure out how we could better serve their community. These pastors were providing volunteer liaisons to the hospital, and the hospital was educating their liaisons, who would take the education back to the congregations.
When Gary Gunderson came on the scene about 2006, he saw this small seed and he felt it would improve the health of the community, but it had to grow to scale. So we set out to redesign the system so it could grow to the scale of the area of the entire hospital system.
We sat down with a “covenant committee” of 12 pastors, mostly from the original group. We asked them to help us design a system that would focus on, first, elevating the health of the community and, second, creating better access for the community to health care.
We set out to do that in five ways. First, we were going to educate the community on health issues and on how to access the healthcare system and the existing resources. Second, we wanted every congregation to have some kind of prevention going on in their congregation. Third, we designed an intervention program for the congregations to be a part of the care for their members while they’re in the hospital and after they’re discharged. Fourth, we created an access program that helps people navigate the healthcare system and the health care they need. Finally, we asked all of our congregations to be involved in aftercare.
These five areas became the foundation for the network, the things we were going to build on. We had four critical areas of health disparity in Memphis: the frail and the elderly, mental health, chronic disease, and infants and mothers. So we designed a system to address those four areas.
What is the structure, how does it work?
First, we have a director, and that’s me. We hired four navigators, who are hospital employees with the responsibility of developing relationships with the congregations in the areas around those hospital sites. We ask that pastors sign a covenant that was developed by the covenant committee, and so in signing that covenant they agree to be in partnership with the hospital. We ask those congregations and pastors to assign at least two congregation liaisons. These liaisons partner with the hospital employees, the navigators, to implement the program not only into the church but also into the into community around the church.
When you began, how did this large healthcare system resist or embrace the program? How did you all integrate this new program that had never been done anywhere before?
We found that it was easier for this network to grow in the community than to flourish inside the hospital system. First, we had to win the trust and support of the strategic planning committee for the system. Gary Gunderson took the lead on framing the argument on how this would benefit the system from a financial viewpoint and benefit the community from a health point of view. Our hypothesis was that this system would lower the length of stay per patient in the hospital; at that time everyone was focused on length of stay. Of course, after we implemented the program, we saw that length of stay was not the most powerful effect; the power of the program is in other areas. We found that the hospital benefited financially because patients who are part of our system use less resources per hospitalization. We also found their rate of readmission is lower and that they stay out of the hospital longer than patients with the same diagnosis.
We wanted to advance the health of the community and create access, but we also knew that we had to be financially responsible and benefit the hospital financially.
Were there any things that surprised you in terms of internal allies?
Our foundation has been our biggest ally in terms of philanthropy of the program. The CEO of the hospital, Gary Shorb, a man of faith and vision, saw this as the system living out its faith in the community. After all, we are an outreach ministry of the United Methodist Church. Gary Shorb was a great ally for us. Certain physicians and administrators really get that community is more than something you go to to feel good, that there are social determinants of health, and if we get into the community we can influence those determinants. If you stay behind the walls of the hospital, you can only affect what comes through the door.
Many within the hospital—who understand that we can influence the health of the community—have helped implement the program and given their time, talent and resources freely. They give the program strength and long-range vision.
Can you give some examples of how the network has benefitted the community?
The network has become a kind of trellis for all kinds of community programs to be implemented. We work with the youth violence for the city, the homeless initiative; we’ve brought our congregations together who have agreed to sponsor homeless families. There’s also an initiative where the county donates blighted properties to congregations that become responsible for the maintenance of these properties. The community sees this network as a viable way of implementing programs that affect more, beyond health related.
Can you talk about how a specific neighborhood benefits?
We’ve just begun the 38109 zip code initiative. We’re going to bring the resources of Methodist Healthcare outside the walls of the hospital in a concerted partnership with other community entities, such as CIGNA, Christ Community Health System and the Church Health Center. We’re going to a really impoverished community with depleted resources that does not have a primary care clinic. We’ve partnered with congregations there, and beginning this year, we’ll be providing primary care. We’re calling it a clinic without walls.
A community navigator and the congregational liaisons will coordinate primary care resources, bringing them to that community in terms of congregations. Congregations will work with us to publicize this resource. They will also identify patients, connect them with primary care and follow them, for example, to make sure they can afford medicine. Congregations have agreed to provide transportation to those who don’t have it. We are creating a web that’s going to try to address some of the social ills of the community and help people get access to health care.
Links to Articles on the Congregational Health Network
- “Tackling a Racial Gap in Breast Cancer Survival,” an article in The New York Times by Tara Parker-Pope, describes a gap in breast cancer survival and what Methodist LeBonheur Health in partnership with others is doing about it. While survival rates have generally risen dramatically among U.S. women, the same is not true for African American women.
- The online news magazine Salon has featured Memphis’s Congregational Health Network. The piece follows the effort from its beginnings in 2007 to the current initiative in the 38109 zip code.
- Sojourners features an article on the Congregational Health Network. Author Bob Smietana says that “the Congregational Health Network (CHN) has become a model for how hospitals and faith communities can work together.”
- The Congregational Network (CHN) is cited in the Feburary 6, 2013, issue of The Journal of the American Medical Association, or JAMA, as a best practice by Drs. Nicholas Stine, Dave Chokshi, and Marc Gourevitch. The article, Improving Population Health in Cities, talks about the recent rise in collaboration “between medical, public health and social service institutions.”
- Here’s an excerpt from a feature on CHN in Christianity Today:
How does a hospital system vastly extend its reach into underserved communities? Methodist Le Bonheur Healthcare in Memphis says it’s through trained volunteers. In an innovative program MLH partnered with almost 400 local congregations that identify key volunteers who (after intensive training) help the patients through their stay and afterwards.
- Early data show the program has cut readmission rates by 20 percent and halved mortality rates. And it’s saved funds — good news as hospitals face financial challenges. It’s even better news for patients who are moving toward better health. Read the Washington Post article here.