Hyper local community healthcare model

While governments are most often seen as solely responsible for creating more equitable societies and protecting the most vulnerable, there is increased acknowledgement that these complex problems can be addressed through collaboration. Government institutions, healthcare organizations and community organizations all have a role to play. Together with the very communities and individuals that are concerned, through hyper local community healthcare models, communities have the democratic mandate, the cultural insight, and the social capital necessary to make long-term and lasting changes. Health outcomes for entire communities can be improved by addressing health inequities, and embedding monitoring, targeted prevention and early intervention.

Australia has a good example of community-led, operated and controlled health organizations. Aboriginal Community Controlled Health Organisations (ACCHOs) deliver holistic, comprehensive and culturally appropriate healthcare services to almost 410,000 Aboriginal and Torres Strait Islander peoples.² ACCHOs are initiated and operated by local Aboriginal communities and are controlled through locally elected Boards of Management.³ Between 2006 and 2019 there was a significant 15 percent decline in avoidable mortality rates for Indigenous Australians⁴ partly due to advances in health care delivery and improved inter-sectoral services.⁵ Aboriginal Community Controlled Health Services have also been found to have a preventative effect upon hospitalizations.⁶

In the United States, the Equity-First Vaccine Initiative is an example of how community-based organizations can be leveraged to address a targeted public health priority (increasing COVID-19 vaccination) and build upon existing trusted community partners that are already addressing root causes of inequity, such as housing and transportation.⁷

These examples from Australia and the US, illustrate how hyper local community healthcare models are responding to the needs of communities by delivering care that is culturally safe, provided in an appropriate manner and based on targeted approaches to the social determinants of health.

When it comes to care delivery, hyper-local models are typically best suited for primary and community care, prevention, and well-being. One such example is Community Cavell Centers in the UK —that aim to integrate primary care, diagnostics, community health services and social care for populations of up to 150,000.⁸ These centers not only play a critical role as brokers to draw on partnerships for certain services such as tertiary care, but they also leverage on funding and accountability agreements to ensure that the health and cultural needs of community members are met outside of the walls of their communities. 

To implement hyper local healthcare models the following three factors are key

• Service and organizational redesign: Health services and organizations will likely need to be redesigned to better reflect the needs of patients and local communities. This may involve: 
  • Vertical integration of hospitals, primary and community care 
  • Scaling up of primary care, creating multidisciplinary settings that are based on more professionalized organizations and back offices   
  • Governance reforms to create stronger voices for local community groups in decision-making
• Data capabilities: Success in delivering on population-specific needs also depends on health system’s ability to triangulate data from multiple sources to gain real time and detailed population level insights. For example, in the United States, the CDC’s Places program provides health data for small areas, which helps local health departments “to better understand the burden and geographic distribution of health measures in their areas” and assists with public health intervention planning.⁹ In order to create preventative and population-based health services, health system EMRs would also need to be integrated and interoperable, and feed into health data centers that act as a centralized data repository and monitoring and command center for local service delivery. Health data centers can transform linked data into actionable insights that can be used to establish proactive population health management approaches.  
• Partnerships: Greater collaboration between all stakeholder groups and industries from the public and private sector is needed to solve the issues of socially driven differences in health equity and accessibility. This calls for increased collaborations and private public partnerships that can help improve health and wellness.  

In closing, I feel that hyper local healthcare models and the caring communities empowered to take on responsibility for keeping their own populations healthy can be one of the biggest drivers of improved health and care in the future.  

• Addressing the structural causes of health inequalities requires attention to the social determinants of health and action beyond health systems. 
• Communities can play a key role in addressing health equity issues through hyper local healthcare delivery models that tailor interventions to address specific local needs and culturally sensitive contexts. 
• Success in delivering on population-specific needs depends on health system’s ability to triangulate data from multiple sources, respond to needs with innovative and timely interventions in collaboration between communities and partners. 

Author: Dr. Anna van Poucke, Global Head of Healthcare at KPMG International