The state of Oregon is finally recognizing that the factors that influence an individual’s health extend far beyond a doctor’s office or lab results. These social determinants of health include housing, adequate nutrition, education, and at the root of it all, financial health.
In early July, the Oregon Health Authority awarded 15 coordinated care organizations one- and five-year contracts totaling over $6 billion annually to administer Medicaid to nearly one million Oregonians. Each CCO was asked to ensure that it met a set of comprehensive health policies advanced by Gov. Kate Brown to improve the health of Oregon Health Plan members in ways that had never been directly addressed before. These CCOs are required to address the social factors that contribute to their clients’ health, with the goal of improving lives far beyond the clinical setting.
The desired long-term outcome of this whole-life approach to health care is presumably improved physical health, ultimately leading to a widespread decrease in health care costs statewide. But how will it work? In my experience, it has to start with financial health.
According to a 2004 study from the University of Wisconsin Public Health Institute, about 50 percent of the factors that determine health outcomes are related to social determinants of health and health equity, while clinical care only accounts for 20 percent. Financial well-being is at the core of these social determinants. Everything — adequate housing, nutrition, transportation, literacy, and much more — is dependent on basic financial health.
There’s even more evidence that improving financial health can contribute to better social health. A recent independent survey of people in the Medford area who were previously homeless and are now transitioning to more stable housing, and have completed a financial education and counseling program in the past 12 months showed dramatic results: 57 percent of the respondents reported that they were now on a personal budget and were sticking to it; 37 percent had started to pay down their debt; 32 percent reported their credit score had improved and 13 percent had even purchased a car. A car! To me, that last statistic is the most impressive. These people are coming from addiction and extreme poverty to overcome a major obstacle to keeping a job, securing food, and obtaining basic medical care. Financial well-being opens doors that some people didn’t even realize were closed.
Measurable outcomes like these must matter to the CCOs around the state as they roll out their vital work of supporting the well-being of Oregonians. The task ahead of them is immense, and it is crucial that they succeed. Knowing that the CCOs have a state-mandated directive to address social determinants of health is like music to my ears, because I’ve seen first-hand that financial well-being can literally be the difference between life or death for some of our most disadvantaged community members. I challenge this new class of CCOs to embrace this revolutionary approach to health care and create a new way forward for all Oregonians in need.
Medford resident Bill Ihle has served as CEO and Executive Director of Consumer Credit Counseling Services of Southern Oregon since 2017.