Personalized, Evidence-based, and Community-driven Care for Older Adults in Haiti and the U.S.

Earlier this year, the Discern Health clinical team gathered for an offsite meeting to connect and set goals for the rest of 2024 and beyond. It was a welcome opportunity to get together in person; while much of our day-to-day work at Discern Health is focused on creating solutions that can scale without individual hands-on care, many of us work remotely in our roles as practicing physicians and nurses outside of Discern.

Our clinical team collaborates closely with data scientists to build accurate predictive analytic models to identify those patients at risk for debilitating health conditions or events such as cognitive decline, congestive heart failure, or even falls. The goal is for our models to allow providers and health plans the opportunity to intervene early and prevent catastrophic events and conditions that reduce longevity and quality of life, particularly for older adults.

Discern Health Hosts Haitian Doctor

As part of our program, I was privileged to invite a special guest to share his story and insights on older adult care.? The hope was to highlight that even in areas of the world with limited medical resources, evidence-based medicine, collaboration and alternative, community-based care delivery models can greatly impact the care and ensuant outcomes of the most vulnerable populations.? Dr. Guerson Meslien ( Peter MESILIEN ) (who goes by Dr. Peter) is a general practitioner born and raised in the village of Neply, Haiti just 700 miles off the coast of Florida. I first met Dr. Peter in 2017 through my volunteer efforts with myLIFEspeaks , a non-profit non-government organization that I joined because it was purpose-built to help establish village and regional-level infrastructure through formation of a public health system, education program, career development, and more, to support those in the community.

On the healthcare delivery front, the organization’s LIFE Clinic sees around 5,000 patients every year. In 2017, I made my first trip to Neply to volunteer as a clinician in their LIFE Clinic and met Dr. Peter.? ?He grew up in one of Haiti’s small, poor villages, and dreamed of becoming a physician, but the means and clear path to fulfill that dream posed challenges to realization.? With experiences in the LIFE clinic and support from MyLIFEspeaks, Dr. Peter attended and graduated from medical school and returned to Neply to serve his fellow Haitians through the practice of medicine at LIFE Clinic.

Just recently, however, increased political instability, gang violence and the targeting of certain professionals like physicians through kidnappings made Haiti too dangerous for Dr. Peter, who is now in the U.S. for his safety. While he is anxious to return to Haiti and continue serving the community, he is using this time to continue his medical education and career, going through the steps to become a candidate for residency.?

I invited Dr. Peter to speak to the Discern clinical team to learn more about the contrasting challenges, but shared opportunities of healthcare delivery models in each country, particularly as it relates to care for older adults. Here are some of the stark differences:

Life expectancy

• U.S.: 76.1
• Haiti: 63

Annual per capita spend on healthcare

• U.S.: $12,600 ($3000 of which is the annual per capita spend on waste due to administrative red tape, failure of care delivery, over treatment, poor care coordination)
• Haiti: $13-83 depending on the data source

The differences are marked on average, but as we delve deeper, we see similar pockets in communities here in the United States where care, spending and outcomes appear to align more with those in Haiti than those in the United States.? When my grandparents and parents emigrated to the U.S., they planted their roots in Newark, New Jersey’s Ironbound District, which to this day is home to a large Portuguese community.? It boasts social and sports clubs, media organizations, religious institutions, restaurants, supermarkets and shopping centers catering to many of the social needs that often drive health outcomes.? I also attended medical school and completed residency in Newark and the experiences in a different census tract could not have been more divergent.? The average life expectancy varies from 69 where I trained to 86 years of age in the community that hosted my family’s first immigrants. That’s a 17-year difference between two areas of the same city not even a mile apart. This highlights the aforementioned social factors that drive the significant difference in outcomes between different neighboring communities in the United States, not only on life expectancy, but on every single morbidity metric impacting it – drugs and alcohol, violence, access issues, education, food deserts, lack of safe places to exercise are all key impactors to morbidity and mortality differences.

Not only are these differences and their subsequent outcome varied, but so too is the spending, with at-risk communities receiving reactive, low-value, location inappropriate care for a myriad of reasons.? This type of care contributes to the nearly one quarter per capita spend on wasteful care.? As Paul Farmer was quoted as saying “It is very expensive to give bad medical care to poor people in a rich country.”

Haiti Older Adult Care

Neply has become a beacon of hope despite being a poor village in a poor country in many social aspects.? Their community-based approach to tackling everything from educational challenges to orphan care has demonstrated outcomes.? On the healthcare front, the LIFE Clinic is open every day, including evenings and early mornings as needed. The clinic provides a range of services from well-visits, emergency care, prenatal care, and preventive older-aged adult care, as well as laboratory services and a therapy center.? The staff coordinates specialty referrals, transportation and care funding.? Medical providers deliver care at home and have developed a model where the eyes and ears of the community not only identify people at risk, but more critically, proactively intervene.? Much of the developed world is challenged with an aging population and a diminishing medical workforce.? Care models will need to change with family members, friends and even technology playing a bigger role in risk selection and intervention as it happens in real time if we expect outcomes for the masses not to be impacted.? In Neply, neighbors are tuned in to declining health and become the first line of defense into contextual access and the care of the most vulnerable begins family intervention, feeding programs, financial assistance, recognizing that a spend on social services, no matter how grassroots, is the best medicine.? The World Health Organization identifies health as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” ??

Dedicated care for older-aged individuals in Neply focuses on managing chronic conditions, including visual, cardiovascular, endocrine, neurological, and musculoskeletal problems or conditions.

It also relies heavily on prevention, including encouraging regular visits, financial support, health education, community engagement, and food and sanitation programs.? It is clear that whether in Neply or in Newark’s Ironbound, community plays a large role in healthcare outcomes.? It not only helps drive healthcare access, but also the social connections, sense of safety and life purpose that extend not only lifespan, but healthspan as well.?

Learning Moment for Discern Clinical Team

The clinical team at Discern Health used this educational moment to not only take stock of the opportunities and limitations of our own healthcare system, but also to realize that while not perfect, the care of at-risk individuals truly takes a village. While we have many more resources, they aren’t always deployed well or equitably, and usually only help certain patient segments. Having the best tests, technology or medicine isn’t enough if there is not a thoughtful plan for their allocation driven by a collectivist approach.?

While we can’t fix the entire healthcare system, we remain committed to helping effect change where we can.? We understand that building predictive analytic models can drive preventative, proactive care and personalized care.? We also understand that we are one piece of the puzzle because we can identify those at risk, but if there is not thoughtful care management for chronic disease and risk-appropriate prevention strategies to tackle all domains of health (physical, mental, social, financial, community), outcomes won’t change.? Quality should be premised on the value care provides and not arbitrarily on the cost of its provision.? In the resource rich country we live in, we need to understand that care in some cases is expensive, but worth it if it leads to a meaningful impact.? By contrast, low-cost care may provide low, or no value to outcomes – this is the waste that often goes unaddressed and damages our health infrastructure.? Said differently, the most expensive test, procedure or treatment isn’t simply the one that costs more, but the one that regardless of cost isn’t expected to make a dent.? We aim to help older Americans live healthier and happier for longer – we do so, by identifying those for whom intervention can make an impact.