Health Evolution

by Capital Analytics Team | from Capital Analytics Associates

For more than a century, Nashville General Hospital (NGH) has been serving the Middle Tennessee community. In an interview with Invest:, CEO Joseph Webb took a deep dive into the exposure of social determinants of health during the pandemic and how to address health inequities moving forward.

What is the economic impact of Nashville General Hospital?

Nashville General is the only public, safety-net hospital in the Middle Tennessee area. We are a 150-bed licensed tertiary hospital with over 700 total employees. From a taxpayer standpoint, one of our goals is to reduce the burden on taxpayers as much as possible. We do this by growing patient revenues, which creates a more fiscally sustainable hospital operation and allows resources to flow back to the city. 

Our services are centered around preventing, managing and detecting illnesses. We have altered the avoidable utilization of our emergency department to provide a care management environment. We teach patients about disease processes and how to avoid getting into crisis through healthy behaviors, which helps to keep them healthier and reduce healthcare costs. This is a major way we contribute to the local economy. 

How did the pandemic expose social determinants of health?

Social determinants of health, which are fundamental causes of health disparities, were exacerbated by the COVID-19 pandemic. Many people may feel as though there was a disproportionate number of minorities who experienced higher fatality rates during the pandemic than are normally seen; an epidemic within a pandemic. But, what actually happened was the pandemic exacerbated an existing situation with health disparities. These individuals were already predisposed because of chronic conditions that create respiratory challenges and COVID attacks the respiratory system. The pandemic exposed elements of our healthcare culture that were dormant in the eyes of many leaders. There was a lack of understanding that social determinants of health cause health disparities, which led to the outcomes we saw with a disproportionate share of minorities experiencing mortality. 

What is needed is an understanding of how to correct the true constraints, which are social determinants of health and health inequities. If we do not address these issues, we will continue to repeat our mistakes, which means that the marginalized members of our communities will continue to be negatively impacted disproportionately.

How is Nashville General Hospital addressing health disparities?

Of all the social determinants of health – access to food, housing, transportation, healthcare, and so on – education attainment carries the strongest correlation among them. If you approach education as being the number one causal factor and focus on changing the trajectory of education attainment, you can have a longitudinal impact on improving the socio-economic status of the targeted population and subsequently redistribute the social determinants of health, which will improve health equity.

Nashville General Hospital has created a faith-based organization called CHEN (Congregational Health and Education Network), focused on education attainment as the primary method for improving and reducing health disparities. It is based on the premise that you cannot achieve health equity until you first achieve a more equitable distribution of the social determinants of health. CHEN engages with populations who are likely to struggle with educational attainment. CHEN now consists of over 100 congregations with more than 15,000 members across Nashville.

Health literacy is another important aspect of health disparities, and a tricky phenomenon. Health literacy is more of a silent killer than anything else. Only 12% of the population is health literate, based on a national survey. Once you factor in and control for social determinants of health, this percentage drops to single digits for the underserved and marginalized population. Health literacy is one of CHEN’s four strategic pillars.

CHEN is collaborating with researchers from the Meharry Medical College-Vanderbilt-Tennessee State University Cancer Partnership in a 5-year study, Engaging Partners in Caring Communities (EPICC), to identify and address the social determinants of health. The EPICC study will examine new approaches to reducing health disparities associated with obesity, hypertension, diabetes, heart disease, and cancer by supporting delivery of evidence-based programs in faith-based organizations serving Nashville’s African American communities. 

What is an example of the Food Pharmacy improving health outcomes?

The Food Pharmacy is an innovative initiative at Nashville General Hospital that focuses on food insecurity and hunger in the community. We evaluate each patient that enters Nashville General for food insecurity and if it is evidenced, we provide healthy and nutritious food that meets the needs of their chronic health conditions. Diabetes and hypertension are two of the most common conditions. 

Nashville General Hospital’s cancer center has been providing multidisciplinary cancer care for 80 years; it’s the second-oldest in Nashville. We realized our cancer patients struggled with food insecurity, could not maintain weight, and risked losing the opportunity of continuing chemo treatments due to weight loss. By providing food as medicine, individuals who cannot afford the food they need to maintain their weight get access to our Food Pharmacy. During our triennial cancer center accreditation, our survival rate was recognized as one of the highest among cancer centers. The main reason for this improved outcome is our ability to maintain the weight of our patients in the program by addressing their food insecurity struggles through Nashville General Hospital’s Food Pharmacy.

What are your top priorities for Nashville General Hospital moving forward?

We are planning to construct a new facility, a state-of-the-art teaching hospital, which aligns well with our status as the index teaching hospital for Meharry Medical College. We have also applied for a trauma-level designation and will continue to focus on evidence-based healthcare delivery. Nashville General Hospital’s healthcare delivery model primarily emanates from empirical evidence or science, which is frequently found in the application of medicine but not so much in management of the delivery of healthcare. Finally, our overarching strategic goal is the IHI Triple Aim of Healthcare: improving the patient experience, improving population outcomes and controlling/lowering cost per capita. That’s our guiding principle.