Harnessing the power of community voice to improve health systems for women

May 22, 2023
© Sean Locke / Stocksy United
© Sean Locke / Stocksy United

Medical systems can be slow responding to the unique needs of individual patients and communities. Bureaucracy hamstrings large healthcare systems and providers. Even when these organizations finally do make changes their patients need, it can take years for them to impact the populations they serve. Putting the patient at the center of care—and listening to what their unique needs are—helps to improve health outcomes.

In Minnesota and Michigan, two organizations are working to incorporate community and user voice into how they work, improving health outcomes and wellbeing. Here's how. 

Community guides the way

The Minneapolis, Minnesota-based start-up Reema Health partners with Medicaid and Medicare members who have gaps between their healthcare, social care, and medical needs. When someone in the community needs a ride to the doctor, a prescription picked up, or is having difficulties with their personal care worker—Reema is there to help. The company's approach is simple and straightforward: they listen to their members and help them make a plan that works for them. They meet individuals where they are.

Currently, Reema is available in three states and expanding to more soon. Reema reaches out to patients on specific plans with the insurance companies they work with, which is the highest need and highest cost members who are often at the margins.

Reema's model is built on what they call community guides, who function similarly to a community health worker and help patients navigate the entire healthcare ecosystem. But they also go beyond the scope of a traditional community health worker and assist their customers in hurdles they may have in their day-to-day life—like transportation or housing—that also have an impact on individual health outcomes.  Reema hires these guides from the communities they serve. 

“We have found that shared identity and shared experience acts as a great headstart that we know is necessary in order to build a relationship,” Reema founder Justin Ley says. “We will do, basically, whatever it takes to help them meet that need: food, housing, transportation, employment.”

After they've built a level of trust and worked to meet any of a patient's urgent needs, the community guides help with more traditional medical realities. “Eventually, we earn a seat at the table to have a more clinical conversation,” Ley explains. “When's the last time you saw a PCP? What kind of conditions are you experiencing? How do you navigate those right now? That's the arc of the relationship. We have to build this trust so that we can talk about the things that we believe have a more linear relationship to an actual reduction in the cost of care to an actual improvement in their lives.”

Centering the voice of the women who we serve is the most important thing that we can do.

Reema avoids the digital realm. There is no app to download. No username or password. They interface strictly with the community guides via in-person visits and text messages, who, in communities where English is not the first language, speak their native language. The community guides are equal parts shepherd, counselor, and caseworker. 

Take, for example, Caroline, a 77-year-old Reema enrollee, who suffered strokes and experiences vertigo. Her mobility is limited, and she has difficulty getting to multiple doctor appointments every month. Reema first built trust by understanding her unmet needs and medical risks and from there was able to improve her health outlook. 

First, after a short hospitalization for vertigo, Caroline's community guide assisted in making her follow-up appointments. Later in the relationship, after a level of trust had been established, Reema arranged transportation so Caroline did not miss her monthly appointments. Throughout the process she expressed the trust she had with her community guide, discussing her family, frustrations with her personal care worker, and diving deep into Black culture. Reema has continued offering Caroline support, especially as it relates to helping her find a new personal care worker.

Michelle, a 57-year-old Reema enrollee living with her uncle in Milwaukee, has long struggled with substance use disorder. In the last year, her community guide helped Michelle improve her health, wellbeing, ability to work, and economic security. The pair navigated technology challenges together, while arranging the prescription medicine Michelle needs and securing transportation for driver's training. The community guide also assisted in setting up Michelle to take exams for her vocational certification and help her write and submit resumes to new job opportunities post-certification.

Reema's community guides are regularly (and anonymously) sharing feedback from patients, which is then incorporated into planning and treatment for everyone else in the Reema system. “Everything is designed based on what we're learning in the field,” Ley says. “We're seeing how it's going anecdotally and qualitatively, learning what works and what doesn't, and improving our program over time. The design comes from the doing.”

Meeting patients where they are

Reema is a start-up bridging gaps in care. University of Michigan Medicine's Community Health Services (CHS) is taking feedback from its beneficiaries and incorporating it into the services they offer. Alfreda Rooks, the director of CHS, has a front row seat. For 23 years at CHS, Rooks has worked on improving equity in health at the University of Michigan Medicine, which serves the larger southeast Michigan community in and around Ann Arbor, where Michigan Medicine is based. 

“Everything that we do is driven by the people that we're serving—and making sure that we are culturally appropriate.”

“If you think of UofM Health as the human body, Community Health Services is the hand that goes out—we take programs and services to the community,” she says. “But then we bring back the experiences, the anecdotal stories about what their folks have seen with healthcare. For the most part, we turn those into opportunities to train our faculty and staff around how to engage with the diverse populations that we serve and how to be culturally appropriate with the folks who come through our doors.” 

CHS has different touchpoints for community engagement where they intake information from the patients and community they serve: Health promotion, health education, print materials, social media campaigns, in-person workshops, and more. Then CHS takes this feedback and vital information from its patients to tweak old programs and pilot new ones.

For example, recent focus groups and listening sessions with mothers in different clinics around access to mammograms led to a new program. 

While the mortality rate for Black women with breast cancer has dropped over the last 30 years, they still have a 40% higher death rate than white women. In Ypsilanti, a town about 10 miles east of Ann Arbor, CHS heard from Black women that they had difficulty getting to their appointments in Ann Arbor. The clinic in Ypsilanti does not have a mammogram machine and many of the community's patients had transportation difficulties getting to and from Ann Arbor during the work day. 

In February, Michigan Medicine's Ypsilanti Health Center launched a mobile mammography van that improves access for members in the community—a direct result of the community engagement and outreach Rooks and her team conducted. 

“Getting  the feedback made us much more conscientious and aware of what we were doing in Ypsilanti and expanding services there,” Rooks says. “We'll be able to take that van into a community where we can really reach mothers who have the worst breast cancer diagnosis outcomes.” 


Rooks points to the work that CHS does with Meals On Wheels as another example of listening in action. Michigan Medicine has a large population of patients who are of Asian descent who, once they turn 60, have access to Meals On Wheels. CHS found, through surveys, that many of their Asian patients were not eating the food that was delivered. “It was culturally different for them,” Rooks says. “They didn't know what it was and they didn't like the taste of it.” 

CHS took action. “We partnered with one of the local restaurants in town, who worked with our patients and nutrition services to make sure that we were meeting all the dietary requirements for senior nutrition to create an Asian meal program,” Rooks says. “Everything that we do is driven by the people that we're serving—and making sure that we are culturally appropriate.”

Putting user voice at the center of healthcare—whether it's a large health system or a start-up bridging gaps in care—helps improve health outcomes and wellbeing, for both current and future patients. Listening to the unique needs of the community and acting on that feedback creates a positive feedback loop. 

“Centering the voice of the women who we serve is the most important thing that we can do,” Rooks says. “Because it doesn't make sense to have a program or provide an intervention if it's not what people need, because they won't come. I always like to say what we do is with community and for community, but the biggest piece of the biggest part of that is that it's with community." 

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