University of Utah (U of U) Health’s Wellness and Integrative Health program is led by Amy Locke, MD, Chair of the Academic Consortium for Integrative Medicine & Health. Locke has taken on the role of Chief Wellness Officer at University of Utah Health to expand a whole-person health approach to programs for employees, patients, and community members.
State of Reform: What is the Osher Collaborative and University of Utah Health’s participation in it?
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Amy Locke: “The Osher Collaborative is 10 health systems across the United States and 1 in Sweden, and Utah is one of the newer members of the collaborative. The idea behind the Osher Collaborative is to bring together people working in different places in different systems to learn from one another around best practices. Each of the centers have programs in education, research, and clinical practice. Increasingly, centers are interested in more community outreach. We’re just barely a member and are getting excited to learn more about how we can work together with the other centers.”
SOR: What is the Wellness and Integrative Health Program and how does it serve communities in Utah?
AL: “Our community programs exist in somewhat of a hub and spokes model. There are things that we offer on-site like [the] behavioral change program, lifestyle change programs, programs for osteoporosis, preventing diabetes program, intensive lifestyle programs for folks who already are worried about a particular diagnosis. Then we have programs that outreach into the community.
Our mobile unit is the wellness bus. It goes to 6 communities in the Lake area. Those are communities that we visit to do a couple of things. We do screenings for health disease. For example, screening for diabetes or high blood pressure, and then we offer coaching around health behavior change. Then we connect people to resources that focus on social determinants of health, helping people with housing, food, insurance, finding a provider, that kind of thing.”
SOR: How has U of U been committed to improving social determinants of health?
AL: “Historically, health systems have felt like, ‘Okay, well, we take care of people who show up to see us.’ That often means that people have insurance and maybe have less need for help with social determinants of health. Just like all over the country, the University of Utah is really thinking about ways to engage with the community, and to think about ways to provide for people regardless of their insurance or other status. One of those ways is the Community Health Needs Assessment, which the university participates in.
The Community Health Needs Assessment is one way to get information and then as a part of driving out diabetes, which is an initiative through the university that has been really geared on trying to help understand what the community needs, [providing] information out to the community. The [wellness] bus program is one of the programs that’s funded by that. We have several community outreach programs that are focused on school based students. We partner with a number of schools across the Intermountain West. Each of those programs has gone out to the community and tried to figure out what the community would like us to help with and then tried to create services that are tailored to what the community is interested in.
We’re currently partnering with the Kim Gardner Institute, again as the bus mobile unit program expands, to really think about [solutions]. We don’t want to just build something and then show up in the community and say, ‘Hey, we’re here.’ We’d much rather really try to find out what’s missing currently. Where can we provide expertise to flush that out?
For example, in many communities, there are some services to provide physician care to folks who don’t have insurance or who are underinsured. But those services often are not matched with helping you to change programming. Things like, ‘How do I eat better?,’ ‘How do I move more?,’ ‘How do I sleep better?,’ ‘How do I connect with myself [and] with the community with meaning and purpose?’ Those foundational health pieces often are overlooked in safety net care, and so that may be a place where services from our office have an opportunity to help round out the things that are available within a community.”
SOR: Is there any other work that U of U Health is currently engaged in to make health care more equitable and accessible?
AL: “Certainly, there are many, many people working in this space and I think that one of the things that we need, especially as a newer center and as a group that is more recently on the scene, is to really think about how to knit together the pieces that are already existing within the health system and community and see where the opportunities are to break down silos. Our food pharmacy program is a great example.
We’re doing a food pharmacy pilot this year that is partnering with the Utah Food Bank, [with their] nutrition care services, which is a critical piece of our hospital and then with academics to try to provide food, actual healthy food, alongside coaching around nutrition. Again, most people don’t need someone to sit them down and say, ‘Hey, vegetables are good for you.’ They need to figure out how to make that a part of your day life. Coaching sometimes can be a much better strategy for folks like that than just coming and saying, like, ‘Hey, I’m going to have you talk to a dietitian about what you should be doing,’ particularly in trying to figure out how to get healthy food to be accessible to people.
The other piece is really digging into the way we use our electronic health systems like our Epic Systems, to measure social determinants of health and to flag folks that are struggling. We’ve got a number of projects right now that are connecting people to 211, which is the Utah resource for getting help with social determinants. Trying to make that seamless so that it’s not that one person has to think of it when you’re talking to a patient but it’s kind of baked into the interaction with populations.”
SOR: Where is the focus of the organization right now at this critical juncture? What are its immediate needs and health policy considerations?
AL: “Like many health centers around the country, we still are operating in a fee-for-service [model]. It makes it very challenging to think about population health and to think about social determinants of health and health behaviors, because those things are not reimbursable. There’s this constant battle of space for [churning] through people in a regular, cheaper service environment, or really [expanding and thinking] about team-based care and whole-person health. Certainly, health policy plays into that because if we can’t offer services to patients that really meet those other needs, it makes it really hard to walk the walk.
For example, the Diabetes Prevention Program is only very recently covered by Medicaid in our state, but still is not covered by many commercial insurances. A program like that has such dramatic impact on health [and] is still in its infancy in terms of being covered more broadly. Expecting patients to pay out of pocket or expecting the system to be able to find scholarships to cover all of those patients is still a very patchwork space.”
This interview was edited for clarity and length.