How life's basic needs can affect our health care.

Some days basic care comes before health care

When a Tufts Health Plan member was struggling to manage her diabetes, care manager Tyisha Peña sensed something stood in the way.

On the surface, everything seemed fine. The single mom in her mid-30s was able to make ends meet. She had a car and a place to live. The worry, however, as Peña soon discovered, was with her eight-year-old daughter.

“Mom had a hectic schedule. She’s working two jobs, getting her daughter to school, rushing home,” Peña said. “They don’t get home ’til 9 o’clock, and then are trying to cram homework in.”

When it came to schoolwork, the daughter was falling behind. Because of this, Mom’s diabetes was ignored.

This is one example of how a person may cast aside their medical issues because of something looming larger in their life, perhaps around food, work, housing, or school.

In the world of public health, these conditions are known as the social determinants of health. They include “the places where people live, learn, work, worship and age” that affect health outcomes and risks, according to Healthy People 2020, cited by the Centers for Disease Control and Prevention.

Tufts Health Plan care managers often work with members to resolve these concerns so that, in turn, members can focus on their health.

Making connections, finding solutions

It’s “acknowledging that we have a problem and then putting together a plan in order to address the problem,” says Duke Dufresne, M.D., a medical director at Tufts Health Plan. He is part of a team that works on finding these solutions for members.

The most common factors that come across, he says, are housing, transportation, food security, and health literacy.

Take transportation, for instance. Some members face challenges when seeking care due to lack of access to a vehicle or public means of transportation.

“It’s transportation for a purpose,” Dufresne says. “Transportation to dialysis, for instance, or to a physician’s appointment.” When necessary, Tufts Health Plan coordinates transportation needs for its most vulnerable members who need to get to appointments.

Food insecurity is another common condition. Members may live “in a food desert,” Dufresne explains, where access to fresh fruits and vegetables is limited. One example of a solution Tufts Health Plan has implemented is a food truck that distributes these items to members who need them.

But by far, housing is the biggest, most challenging concern for some members. Some are homeless, whether they are on the street or couch-surfing. Tufts Health Plan care managers often assist with paperwork to help members get on housing lists while in the meantime supporting them with other needs.

Meeting a member where they are 

When a member is flagged for a medical concern and referred to a care manager like Tyisha Peña, she will make an initial phone call and conduct an assessment of health-related conditions as well as social challenges. This immediately helps provide a more holistic view of what’s happening with the member.

However, a phone call might not be enough to discover the root cause of a problem. It’s at this point that Peña and other care managers like her arrange for a conversation in person.

“I meet you in your home, I’ll meet you in a coffee shop,” she says. “It doesn’t really matter where I meet you, I just want you to feel comfortable talking to me.”

These conversations are personal. They involve sensitive or private information. “I’m not here to blame, shame, or judge,” she tells her members, “I’m here to listen and help.”

For the mom and daughter, a face-to-face conversation was essential. They met at the mother’s home. “I said, ‘Hey, what’s going on? Help me understand so I can connect you to the right resources,’” she says.

It always is up to the member how much they are willing to share, and how much help they are willing to accept. Sometimes pride gets in the way. Sometimes there’s a language barrier. Other times, it’s emotions.

“People are human,” says Dufresne. “Sometimes they want to give up; they have every right to do that,” he says. “But what we say internally is we never have the right to give up on our members.”

As a health plan, he says, it’s a responsibility.

One goal at a time

For this mom, Peña found a solution. Hectic days leading into jam-packed nights could be resolved by sending her daughter to an after-school program.

The member hadn’t known about it, and was concerned she couldn’t afford it, Peña said, “but I said, ‘Wait, let’s try this out.’” She helped the member negotiate a sliding scale. And the school agreed.

“It took off that worry about how she’s picking her daughter up from school, if she’s doing her homework, who&rsqu

One small change made a big difference. But it didn’t mean it was the only change.

Over the course of several months Peña was the point of contact for this mom for other concerns that came in the way of managing her health.

As Peña puts it: “I always tell [members], case closed doesn’t mean it’s done. Two months from now, if you have another goal, give us a call. And we’ll help you from there.”