Zero-Sum Game Need Not Be Played

Just when I was about to start listing all the ways that Pathways could partner even more closely with UNM Hospitals to improve the health and wellness of people living in Bernalillo County, I was struck by the straw man argument put up by UNM Chancellor Paul Roth at a special budget meeting recently with the Bernalillo County Commission.

“I think Pathways is important, as well, but,”  he begins at a recent meeting. “We have requests from programs that are just as passionate. We want to be able to develop a comprehensive” this and that.

With its “extra money” Roth says the hospital must make a “Sophie’s Choice.” Deciding which of your children to let die is a “Sophie’s Choice.”

But in the case of UNM Hospitals, the stakes are nowhere nearly as high. In fact, UNM Hospitals is doing so well, it has amassed $217 million in capital funds – largely taxpayer dollars that Roth and UNMH CEO Steve McKernan are saving up for a new hospital. They have been adding more than $10 million per year to the balance sheet. Not bad?

In his Sophie’s Choice analogy, Roth pitted Pathways up against stroke, heart and cancer care.  No one wants to jeopardize the quality of care we have come to expect from our state’s only Level I Trauma Center, or from the hospital’s National Cancer-Institute-designated Comprehensive Cancer Center, or comprehensive stroke, neuro-trauma, burn and pediatric cardiothoracic surgery programs.

So why would Dr. Roth suggest that increasing Pathways funding would  present such an impossible choice?  Afterall, the hospital’s budget is nearly $1 Billion per year. It is subsidized generously by a rather uncommon property tax in Bernalillo County that generated $96 million last year, up from $93 million the year before, and $92 million the year before that, and so on for the past several decades. Roth characterizes our property tax contribution as as a very “small” portion of the budget – less than 10%.

From that very “small” taxpayer fund, the Pathways Program is funded at $800,000 per year.  That’s less than one-tenth of one percent.

That money is then earned by 16 Community Health Workers, $150 at a time. For every measurable goal achieved by a client, the Pathways worker who helped is allowed to bill Pathways for $150.  This is pay for performance.  This is paying for results.

Pathways is limited by its budget to serve a maximum of  about 500 clients per year. By design, the Pathways program targets the county’s most vulnerable residents, of which there are thousands living below the poverty level, at-risk of experiencing homelessness, and going without food, heat, electricity and other basic necessities of life.

The program requested $2 million, to be able to reach ~800 more people. The program has proven its efficacy over and over again, with statistics and stories showing the impact the navigators’ work is having on individuals, families and on the community as a whole.  Most recently, the program commissioned an independent economic analysis – asking what the return on investment (ROI) is of getting someone housed, employed, or fed.

The rate of return is greater than 3 to 1. That means the $800,000 invested is resulting in $2.4 million in savings and/or earned income for the individuals and communities served.

But Dr. Roth swept that powerful indicator aside, telling the Bernalillo County Commission he has “given up” on the idea that helping poor people will ever save money.

The real question is, to whom do those savings accrue? They accrue to us – the taxpayers.  They do not accrue to the hospital’s income statements or to its mounting cash balances.

I'm sure UNMH CEO Steve McKernan can think of a million ways to spend a million dollars, and Pathways organizations can think of two million reasons to invest $2 M in community health.

The unfortunate travesty is that we are forced to debate the merits of hospital vs. community care - a false equivalence. Instead, we should be working much more closely, collaborating on as many health promoting practices that we can afford together by leveraging our collective resources. But that would make too much sense- sense of a world that pits your care over ours, a zero- sum game that serves none of us well.

 

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commented 2017-08-28 07:10:20 -0600 · Flag
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Building a healthy community in the South Valley of ABQ