The Client Challenge

The community served by Memorial Hermann Southwest (MHSW) is incredibly vibrant, with over 85 languages spoken across a diverse, growing population and a robust ecosystem of community-based organizations, universities, and small businesses. Southwest Houston faces significant health and wellbeing disparities across many social determinants of health (SDOH). As is true nationally, needs align dramatically along racial lines, with Black residents experiencing some of the poorest outcomes.

For MHSW, this situation posed two challenges. First, a high rate of potentially preventable hospitalizations, paired with low rates of insurance, posed a severe financial strain to the institution. Second, as an Anchor Institution, MHSW is committed to improving the health of Southwest Houston’s most underserved residents and to broadly uplifting the Southwest Houston community through place-based initiatives. It sought to significantly advance and expand these efforts to meet growing needs.

  • 17-year gap in life expectancy between Black residents vs. white residents

  • 45% rate of uninsurance vs. 9% nationally

  • 40% of residents experience food insecurity or barriers to seeking medical care due to lack of transportation

  • 60% of ED visits and 30% of hospitalizations by uninsured residents were potentially avoidable

Navigating to Next: The Solution

MHSW and system leadership undertook a comprehensive planning effort with the help of The Chartis Group to shape and execute an innovative, community-focused strategic plan. Chartis helped MHSW understand analogous efforts that systems undertake nationally to drive community change, which span a spectrum from more asset-light, SDOH-focused solutions to more acute care, asset-heavy-focused solutions, oftentimes with coordination across multiple stakeholders. Chartis also enabled MHSW to create strategies customized to Southwest Houston.

Navigating to Next: Key Components

Investing in Equitable Outcomes

Hospital-focused vs. community-focused solutions:

The team identified the greatest need as asset-light enhanced preventative care and care coordination, rather than CAPEX intensive acute services. We focused on the 3% highest utilizers, who drove 50% of hospital losses tied to preventable admissions.

Investing in Equitable Outcomes

Partnered solutions vs. solo solutions:

The myriad solutions needed by the population drove the team to develop a plan for partnering creatively with other providers and organizations to collectively improve the health status of the community; the health system could not feasibly provide them all.

Investing in Equitable Outcomes

Single “big bets” vs. a tapestry of initiatives:

Due to the complexity of the issues facing the population, no single “off-the-shelf” solution would affect the desired community change. Instead, leadership wove together a tapestry of initiatives that spanned disparate yet interrelated efforts.

Client Impact

Memorial Hermann Health System recognizes that outcomes in these complex cases of community health equity take many years to fully realize. Leadership is currently executing the plan in a systematic way, with an initial prioritized focus on developing a more robust model for primary care for the most underserved and on convening wide-ranging community partners to dramatically scale workforce development and local employment initiatives.

These efforts will make a considerable impact on the Southwest Houston community, including:
550 K

residents better served with excellent clinical care and resources to meet SDOH needs

1000 +

medically complex patients provided with more robust, high-intensity primary care

100 s

of jobs across multiple partnering institutions that can be targets for local workforce development efforts

How We Are Making Healthcare Better

Chartis has been an invaluable partner by helping us advance our journey as an anchor institution and enhancing our operating model to meet the current and future needs of our community. ”

Malisha Patel

Next Intelligence

Health systems can strategically address health inequities through a range of efforts such as:
  • Intensive primary care: Increasing access to asset-light preventive care
  • Coalition-based solutions: Working with myriad partners that focus on the most prevalent SDOH needs
  • Targeted cohorts: Focusing on the highest impact cohorts, where outcomes drive the largest value

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