Shelley White-Means, PhD, a professor of health economics at the University of Tennessee Health Science Center, is the principal investigator of a $298,368 grant from the Robert Wood Johnson Foundation (RWJF) to examine whether health outcomes for low-income individuals will improve if primary care delivery focuses not only on physical and mental health, but also on the effects of poverty.
Dr. White-Means will lead a team for the 18-month project to test how an established model of care, Transition to Success (TTS), which focuses on mental health, physical health, and poverty and its consequences, impacts health care delivery and outcomes for patients of Cherokee Health Systems, a non-profit provider of primary care services to the poor and uninsured in Tennessee, with centers in Memphis.
“This project will examine if Transition to Success (TTS) will lead to improvements in the social determinants of health (SDOH); reductions in health care use; improved health conditions; and reductions in the overall cost of care for low-income Medicaid-eligible Black and Hispanic patients,” the grant application said. “There is a gap in knowledge related to whether health outcomes can be further enhanced and sustained by the integration of SDOH treatment into a setting that traditionally focuses on treatment of physical and mental health.”
Dr. White-Means, a faculty member in the Department of Interprofessional Education in the College of Graduate Health Sciences and the UTHSC Institute for Health Outcomes and Policy, said this collaboration with Cherokee Health Systems and its centers in Frayser and the Parkway Village area represents a fundamental change in health care delivery by adding a third element to the current model that focuses on physical and mental health.
“We’re implementing a structural change in the provision of health care that incorporates treatment of poverty, along with treatment of physical and mental health,” she said. “If we treat poverty, then we can minimize the development of some of the other chronic conditions that occur as a result of poverty.”
Transition to Success is a delivery of care model developed by Marcella Wilson, PhD, a former managed health care administrator in Detroit. TTS aims to better treat individuals living in poverty by providing a patient-centered approach to addressing their needs. It has been widely implemented in social-service delivery, but has had limited exposure in health care systems, Dr. White-Means said.
TTS-trained coaches assess the status of patients through the lens of the social determinants of health, considering needs such as food, transportation, housing, employment, insurance, childcare, all of which can be barriers to accessing health care and compliance with treatment plans. TTS coaches also help patients develop long-term goals for health and life. Because Memphis has a large network of TTS-informed agencies, referrals to necessary services can be made during the health care visit, with follow-up and coordination by TTS coaches.
Dr. White-Means and her collaborators, which include Altha Stewart, MD, senior associate dean for Community Health Engagement in the College of Medicine at UTHSC; TTS founder Marcella Wilson, PhD; TTS; and Cherokee Health Systems, will organize the project and assess the effects of this poverty-health connection in the hopes that the results will lead to a new three-pronged model for health care delivery.
“The next step would be a more broad-scale intervention, which would be to take this poverty treatment and incorporate it into the treatment in other clinical settings,” Dr. White-Means said.
This project is one of nine funded nationally by RWJF and Avalere, its partner, in their effort to advance health equity. Among other recipients are: Johns Hopkins University School of Medicine, University Hospitals Cleveland Medical Center, and the San Francisco Department of Public Health.