Care for Special Populations Requires Identifying Barriers, Solutions

During a general session at Health Care Quality Congress, Pamela Riley, MD, MPH, medical director of the Department of Health Care Finance at the Government of the District of Columbia, discussed the health care needs of vulnerable populations and explained health system barriers and solutions that impact this population.

Dr Riley started the presentation by explaining to the audience what defines a vulnerable population. She said that populations that are vulnerable to poor health care or poor health outcomes are due to income, race and ethnicity, language barriers, and immigration status. Particularly, Dr Riley said that a low-income population experience:

• Poorer health status;
• Poorer access to care;
• Fewer preventive care services; and,
• Greater social needs.

Dr Riley then told the audience that a low-income patient faces many health system barriers.

She said, “Most low-income patients seek care at private offices or health centers, but nearly 20% have no usual source of care.”

For providers serving low-income populations, Dr Riley said that a few of the challenges they face include:

• Two-thirds of primary care providers (PCP) do not feel that their practice is well-prepared to manage care for patients with mental illness and substance abuse problems;
• Roughly half of PCPs do not feel that their practice is prepared for the management of patients in need of social services within the community; and,
• Six in 10, or 62%, of PCPs said that it is very or somewhat difficult to coordinate care with social services and community providers.

Despite social barriers, Dr Riley explained health system solutions that she believes will improve the quality of care for a low-income population. To serve a low-income population with high-quality care, providers must address the physical, social, and behavioral health needs of a patient. Further, health care services must be easily accessible in clinical settings or through alternative models of care delivery. And finally, she said that health care providers must be trusted in the community and are proactively addressing sociocultural barriers to primary care access. Dr Riley said that it is important to create this high-fidelity health care system for vulnerable populations.

Dr Riley also said that key opportunity areas, including understanding population needs, providing high-quality services that address specific needs and challenges, and proactively addressing sociocultural impediments to engaging in care are all health system solutions for improving patient care within a vulnerable population. She also said that understanding population needs such as chronic conditions, social needs, mental health and substance abuse disorders, race and ethnicity, environmental risks, and geography factors, all impact the quality of patient care.

She stressed that it is important that community health works are engaged with vulnerable populations in care. She said that community health workers are the core of communities and health and social services. These workers:

• Build individual and community capacity;
• Advocate for individual and community needs;
• Provide direct services;
• Promote wellness by providing culturally appropriate health information to clients and providers; and
• Assist in navigating the health and human services system.

Dr Riley said that although building health care and community partnerships is a multi-step process, she explained that by addressing socioeconomic barriers to access and utilization, high-quality comprehensive services that address physical, behavioral health, and social needs are identified, which result in patients actively engaging in their care.

—Julie Gould