Medicaid covers the cost of 51 percent of all the babies born in Oregon, according to Dr. David Labby, chief medical officer of Health Share of Oregon. “If you want to move upstream, start at the beginning.”
“Who are the high utilizers of healthcare?” he asked, “People who struggle most. People who had a terrible time in life.” In a survey among people considered high utilizers of healthcare, who were on Medicaid as children:
- 66 percent suffered abuse as children
- 40 percent lived with adult substance abusers
- 23 percent had been separated from birth parents
- 50 percent struggled in school
- Only 40 percent graduated from high school
As adults, the same survey found:
- 66 percent started using substances before age 20
- 29 percent experienced homelessness
- 60 percent struggle with mental illness
- 50 percent have been in jail
- 50 percent are socially isolated
- None have regular employment
“They report difficulty getting healthcare. We think they’re ‘high utilizers’,” said Labby.
When Labby mentioned how trauma recovery and resilience programs could coordinate care with social workers, Dr. Ryan Skelton, a clinical psychologist questioned why this population was being called “high utilizers.” Those who survive trauma “may not see themselves as trauma survivors,” he said, suggesting using the terminology “high need” or “people in a moment of high need?”
Gary Cobb, a health resilience specialist at Central City Concern, is concerned about labels that appear on hospital charts defining people as “gang bangers” and such. “Do they need to be labeled?” he asked.
Focusing on prevention, Labby asked the council to consider several suggestions:
- Ask women if they intend to become pregnant. If so, connect them with resources. If not, ask what’s being done to prevent pregnancy and help them find resources.
- Infants: healthy with stable, nurturing attachments
- Children 1-6: healthy and ready for kindergarten
- Children 7-12: healthy, thriving, successful in school
- Adolescents: healthy, avoiding risky behaviors, graduate high school
Well child screenings might be the time to screen for more than diabetes and asthma. “Are you using drugs? Are you pregnant? Are you intending to be pregnant?” might be the kind of questions to ask teens, Labby said.
He wasn’t sure how Health Share might support its partner groups. “Not sure we know yet. We can’t do everything so we’ll have to choose. What are we willing to commit to and what do we want our partners to do?”
CEO Janet Meyer said the advisory council has a “real opportunity to reach out. “Tell the board to support this work.”
Health Share has also created a position to help coordinate care for its 3,000-4,000 children in foster care. These children are “some of our most vulnerable clients,” Meyer said. “If we can’t do a good job on this population, we’re in the wrong business.”
The systems serving children in foster care are “really, really disjointed”, said Ebony Clarke, Multnomah County Mental Health senior program manager, with data from one entity not reaching other entities.
Jan can be reached at [email protected].
