According to Chris Leto, Director of Outreach & Special Programs for Bushwick-based preventative health care non-profit Riseboro, his employer is politically neutral. However, given the nature of the 46-year-old organization’s work — which includes elder care, job placement, local art promotion and the “human touch” that is often missing from hospital environments — such a statement rings more than a little coy.
Because in America, where the issue of healthcare is as sharply risen along partisan lines as abortion, defense spending, and immigration, Riseboro’s compassionate modus operandi is political by default. (The website’s “About” section also contains a hint as to their stance towards the politically charged subject of gentrification: “Our inclusive approach…ensures that nobody is left behind in times of growth.”)
Riseboro, however, seems to have a very real stake in not officially espousing a specific party line; Leto elaborates, its current source of funding is the seemingly miraculous result of a bipartisan agreement that allows the state and hospitals to cut costs AND improve the lives and health of lower income citizens with chronic health issues.
That agreement, known as DISRIP (Delivery System Reform Incentive Payment), started in 2015. Its aim was, and is, to reduce emergency room visits and hospital admissions by 25 percent in the program’s first five years. How? By culling from crowded emergency room ledgers those suffering from, for instance, diabetes and asthma, i.e., diseases whose effects can be ameliorated by the right preventive care.
The process starts with the state and/or hospitals contracting with Managed Care Organizations (MCOs), who then reach out to various Community Based Organizations (CBO), many of whom traffic in a more grassroots approach in promoting the health of their constituents; Riseboro is just one of many CBOs working under the DISRIP umbrella.
Starting November 1, Riseboro, whose operations are centered mainly around the Broadway/Myrtle area of Bushwick, will expand its services to include home visits addressing issues ranging from loneliness and diabetes to asthma and food insecurity. They’ll be partnering with Empire Blue Cross Blue Shield (also known as Anthem), one of the aforementioned MCOs forming an important part of the complicated DISRIP apparatus.
“It was Anthem who came to us and said, ‘You have people who know how to make people feel comfortable when you come into their homes,’” explained Leto over the phone to Bushwick Daily. “Anthem’s purview is medication, doctor visits, etc, but what’s causing this person to come to the MCO or emergency room so often in the first place? What is the doctor not hearing about? What can we do to combat the issues that don’t come up during visits with doctors and nurses?”
A phrase that Leto repeated several times during our interview was “social determinants of health.” It’s a concept that lies at the heart of everything Riseboro does. Taken together, the concept constitutes a complex tangle of factors affecting clients’ health for the better or for the worse — and it’s usually worse — correctly pinpointing these factors makes up a huge portion of Riseboro’s workload.
Two ways that Riseboro makes heavy use of the “social determinants of health” concept are found in its food, wellness, and diabetes home assessment programs. Leto is currently spearheading both.
“Smoking. It’s hard to give up,” said Leto when asked about some of the “determinants” that may result in or exacerbate asthma, a major health issue for Bushwick residents. “Also, allergies to pets; people are very fond of their pets. So we identify areas that should be off limits to pets, like bedrooms, and make sure dander is kept out of the air. We look for rodents and mice in homes, too. People are extremely allergic to the debris they leave behind. Finally, mold, and general cleanliness.”
Most intriguing, though, are Riseboro’s initiatives relating to diet and its effects on health. These include the installation in hospitals of special “food navigators,” who receive patients that, after an initial “social determinants of health” screening by hospital staff, are found to suffer from some form of food insecurity. This is where Riseboro’s “human touch” comes into play: a conversation ensues between patient and food navigator that delves deep into the former’s everyday life, a kind of forensic investigation aimed at identifying the insidious patterns that undermine health.
“It might be related to diabetes,” said Leto. “Or it could be housing: they’re kitchen is broken and they’ve had to eat out for months – there are all these weird little issues that come up. So what the food navigator is doing is putting together a list of resources and referrals. And then, instead of giving them a long list of agencies they’ve never heard of, we use a referral system database to put in the patient’s info, which gets sent to the right organizations best suited to help them.”
In other words, a bureaucracy that takes into account the paralysing fatigue and frustration that often result in the average layman’s attempt to get from A to B on their own.
Bureaucracy fatigue isn’t the only thing against which Riseboro seeks to push. Diabetes sufferers, in Leto’s experience, face another daunting obstacle: their own cultural milieu. By extension, this struggle against ingrained habits becomes Riseboro’s challenge.
“Sometimes [treating or preventing diabetes] is a fight against cultural upbringing,” said Leto. “They’ve been eating a certain way their entire lives. So we’ve been offering cooking classes for about a year now.”
Leto, however, was quick to assert Riseboro’s opposition to a high-handed approach to patient care, in their cooking program and elsewhere.
“They’re what we call ‘culturally competent cooking classes,’ where we’re not trying to teach people to cook other cultures’ foods. Instead, we look at the cultures in different neighborhoods and just adding healthier foods, fruits and vegetables. We’re happy about the response so far.”
Riseboro’s cooking classes have received a ringing endorsement from the New York Academy of Medicine, who found that pre-diabetics – i.e., those in danger of becoming diabetic – had backed away from the diabetes “danger zone” after a year following the program. It’s a handy proof of concept which should inspire confidence in potential donors.
Riseboro is, at least in part, in the business of keeping people away from a health care industry which treats symptoms, but has little vested interest in prevention. It makes the whole DISRIP program, which sees the collaboration of CBOs like Riseboro, MCOs like Empire Blue Cross Blue Shield and various medical organizations, more than a little contradictory, at least to someone not versed in its full byzantine complexity.
Whatever the case, DISRIP has provided a dependable revenue stream for Riseboro, which for a community non-profit is huge: it means not having to go begging every year for new sources of funding. Strange bedfellows or not, the collaboration seems to be working, which is great news for residents of Bushwick who stand to benefit from Riseboro’s new home-visit ministrations.
“There’s excitement for all involved to keep going,” enthused Leto. “It’s been a huge success and as a result the state has reached out to other CBOs and hospitals to create DISRIP 2.0. We don’t want to lose momentum.”
To learn more about Riseboro, go to riseboro.org.
Cover image courtesy of Riseboro.
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