How Medical-Legal Partnerships Create Health Care Efficiencies
By Amit Chitre, CEO/Founder R3Communications
Patients and health care professionals often talk about integrating systems of care to improve health. If a patient’s nurse, physician, surgeon, pharmacist, rehabilitation facility and insurance company are all working in concert, the patient is more likely to experience an optimal outcome. A recent national trend has shown one more specialty group joining this list of coordinated care providers, though not from the medical community. Lawyers are increasingly offering services as patient advocates within the context of a medical-legal partnership (MLP), and these partnerships have shown potential to significantly influence individual and population health.
On its surface, the idea of lawyers working with medical professionals to drive patient health seems incongruous. Medical malpractice lawsuits often pit legal and medical professionals on opposite sides of the patient advocate debate. But a closer look at social determinants of health reveals an opportunity for legal professionals to play a role in health care. The World Health Organization defines social determinants of health as the conditions in which people are born, grow, live, work and age that can influence their health outcomes. Access to care, affordability, poverty, literacy, environment, workplace safety and community infrastructure are all factors that impact an individual’s well-being that health care professionals alone cannot address.
Many of these factors also fall beyond the influence of individual patients, creating both legal and health issues for individuals and families. For example, the National Center for Medical Legal Partnerships outlines some of the most common social and legal problems vulnerable communities may face. The Center developed the acronym I-HELP to identify the following health-harming conditions: income, housing, education and employment, legal status, and personal and family stability. Legal aid can help mitigate the negative impact of these factors on health and health care, which is why MLPs can be an effective tool.
The concept of MLPs originated roughly 50 years ago. In 1967, Dr. Jack Geiger hired a lawyer in Mississippi to address food and housing issues for patients. These types of partnerships picked up more momentum during the AIDS epidemic in the 1980s when health care workers teamed up with legal aid agencies to provide end-of-life care for AIDS patients. Over the next several decades, MLPs took on a variety of issues from mold in apartments that led to pediatric asthma, to use of medicinal marijuana. Today, more than 155 hospitals, 139 health centers and 34 health schools participate in MLPs across the country.
The Legal Services Corporation is a nonprofit that promotes equal access to justice and offers grants for legal assistance to low-income Americans. A 2009 LSC report indicates low-income Americans are particularly vulnerable as they have, on average, two to three health-harming civil legal needs. Poverty, and frequent use of emergency health care services, are two common characteristics among those who might benefit from MLPs. These highest users of our health care system, called “superutilizers” are often driven by the social determinants of health which remain unaddressed due to a lack of coordination between social service, health care and civil legal aid.
Between 2011 and 2012, Lancaster General Health conducted a superutilizer pilot in which it embedded a lawyer into a multidisciplinary team of social workers, nurses, physicians, pharmacists and other health care workers. Of the 55 patients enrolled in the pilot program, 52 had two or more civil legal problems impacting their healthcare use. One patient in particular experienced a domino effect through legal intervention in his health care. With civil legal help, the patient took more financial ownership of his medical conditions, applied for and received bariatric surgery, lost 150 pounds, moved his family into better housing, and is looking for full-time employment. As a result, the hospital and patient both spent significantly less on his health care, and the patient has not returned to the hospital since his initial enrollment in the pilot program.
Benefits of MLPs can extend far beyond individual patients. Addressing social determinants of health has the potential to impact population health. Leveraging legal channels to bring housing conditions into compliance can improve the health of an entire community. Those same channels to expand access to preventive care can benefit generations of Americans. Just as the Lancaster General Health pilot study patient experienced a positive domino effect, so too can the entire health care system. Improving or eliminating the conditions that lead to poor health outcomes can prevent healthy individuals from becoming patients. This will allow health care workers to focus time and resources on other patients in need of care — potentially realizing efficiencies and savings for the entire industry.
There are limitations to MLPs, and unsurprisingly, they often relate to resources and funding. Current civil legal aid groups have only enough resources to address 20 percent of civil need. This forces MLPs to focus their limited resources on emergency needs like housing evictions, rather than preventive measures. Health care facilities interested in forming or expanding MLPs might turn to government and private/corporate philanthropy for funding. The early success of MLPs suggest the investment will be worth the benefit for individual and population health.
Interested in learning more about Medical Legal Partnerships? Check out the National Center for Medical-Legal Partnership at the Milken Institute School of Public Health. Founded in 2006, the National Center for Medical-Legal Partnership’s mission is to improve the health and well-being of people and communities by leading health, public health, and legal sectors in an integrated, upstream approach to combating health-harming social conditions. As a project in the Department of Health Policy and Management at the Milken Institute School of Public Health, it drives the development of metrics, resources, and financing strategies to help these sectors better serve children, chronically ill adults, the elderly, Native Americans, veterans, and other vulnerable populations. In 2016, the Center received a $2 million grant from the Robert Wood Johnson Foundation to study the benefits of legal interventions on patients and health care organizations.