CHITREC to participate in project to link patients to community resources

June 6, 2012

CHITREC will partner with the University of Chicago on a new project aimed at providing better information to patients about healthcare resources in their communities.

The U.S. Department of Health and Human Services has awarded $5.9 million to a University of Chicago Medicine-led program called CommunityRx, a system to be managed by the South Side Health and Vitality Studies. The project was among the 26 programs selected nationwide — and the only one in Illinois — to receive part of the $122.6 million in federal Health Care Innovation awards, made possible by the Affordable Care Act.

The goal of the CommunityRx program is to set up a real-time, automated system that will link a patient with up-to-date information about community-based services and resources. CommunityRx will include a continuously updated electronic database of community health resources that will connect to the electronic health records of local safety net providers.

The program is expected to serve approximately 200,000 beneficiaries of the South Side, many of whom are covered by Medicare, Medicaid or the Illinois Comprehensive Health Insurance Plan. In real time, the system will process patient data and print out a “Health.eRx” for the patient, including referrals to community resources relevant to the patient’s condition and health status.

“Our innovation helps people stay healthy and manage disease by connecting them to businesses and support organizations in their community,” said Stacy Tessler Lindau, MD, associate professor of obstetrics and gynecology at the University of Chicago Medicine and lead researcher for this project. “The outcome will be better and more efficient health care delivery and stronger, more vital communities. That’s ultimately the way we’ll cut cost from the system. I see this investment as a validation of the innovative, community-engaged approach that the University of Chicago Medicine and its South Side partners, including our youth, are taking to transform urban health.”

The development of the program will be housed at the University of Chicago’s South Side Health and Vitality Studies, in partnership with CHITREC and the Alliance of Chicago Community Health Services. CHITREC will help drive much of the education and outreach around the program.

“This project recognizes the importance of community in driving improved health outcomes, a lesson I learned from one of the patients in my own clinical practice” said Abel Kho MD, MS, assistant professor of medicine at the Northwestern Feinberg School of Medicine and the co-executive director at CHITREC. “As an organization supporting effective use of electronic health records throughout the Chicago community, we are excited to partner with Stacy and her team to help connect patients and providers with the most relevant community resources.”

The 26 projects were selected for their innovative solutions to deliver high quality medical care efficiently and enhance the health care workforce. Program designers say CommunityRx could drive immediate positive outcomes. For instance, a physician at Komed Holman Health Center, one of the first sites for the system rollout, would use data on nearby resources to help a diabetes patient follow through with a laundry list of health recommendations. The patient would leave with an auto-generated list of health care providers such as a podiatrist, a business such as a drugstore that stocks diabetic needs, and the closest sources for healthy food such as a farmer’s market or grocery store.

As part of the CommunityRx program, aggregated data on patient diagnoses and referrals will be used to generate reports for community-based service providers to use. The CommunityRx will build on infrastructure supported by funding from the National Institute on Aging. Anticipated outcomes include better population health, better use of appropriate services, increased compliance with care, and fewer avoidable visits to the emergency room with estimated savings of approximately $6.4 million.

“We can’t wait to support innovative projects that will save money and make our health care system stronger,” Health and Human Services Secretary Kathleen Sebelius said in a statement today announcing the winners. “It’s yet another way we are supporting local communities now in their efforts to provide better care and lower cost.”

The CommunityRx system will train and create new jobs for an estimated 90 individuals from the South Side. This includes high school youth who will collect data on community health resources as part of the South Side Health and Vitality Studies’ MAPSCorps program. It will also include the creation of a new type of health worker, Community Health Information Experts (CHIEfs), who will assist patients in using the Health.eRx and engage community-based service providers in meaningful use of the CommunityRx reports.

Read the full press release here.