In New Orleans, a Health Plan for the Poor Comes Together

Hurricane Katrina destroyed “Big Charity,” but the Big Easy has something better.
February 8, 2016
By Ron Littlefield  |  Senior Fellow
Ron Littlefield, a former mayor of Chattanooga, Tenn., is a senior fellow with the Governing Institute and its lead analyst on the City Accelerator initiative. A city planner by career, he also consults to government through Littlefield Associates.

In the 1980s' action/adventure television series "The A Team,” things often went from bad to worse until the lead character, Colonel John "Hannibal" Smith, would spout his famous line: “I love it when a plan comes together.” After more plot twists and turns, the team would overcome insurmountable odds, snatching an unlikely victory from almost certain defeat.

For the past decade, exceptional conditions in New Orleans have played out much like an episode of that old drama. Most notably was Hurricane Katrina, which left the city in ruins in 2005. The process of recovering from that disaster has been a long and often painful road.

Among the essential basic elements of any city is its health care system. Before Katrina, much of New Orleans’ health care – particularly for poor citizens – revolved around Charity Hospital, affectionately known as “Big Charity.” Starting out in a small cottage in 1736, more than 300 years later Charity Hospital was a 2,600-bed comprehensive public health institution.

But Big Charity proved to be no match for Katrina. The hospital never reopened its doors after sustaining severe flooding. Understandably, the loss of Charity Hospital after more than three centuries of service was disruptive and controversial. But the story doesn’t end there – it can’t. Health care for a city’s poorest citizens is not something to be ignored and New Orleans has moved decisively to fill the void left by the loss of Big Charity.

During the decade since Katrina, New Orleans developed a network of 60 community health centers – dispersed across the map and tucked into neighborhoods – to serve its neediest people. Some of these centers are even designed to serve special populations such as the musicians who make New Orleans’ culture so unique. Even with all of its history, restaurants and cultural attractions, the economic health of New Orleans' important tourist economy is tied in no small way to the health of some of its most vulnerable citizens.

The system the city developed is much like a wellness program found in an employer’s benefits package. In this case, however, the wellness program is designed to serve the needs of approximately 140,000 people in poverty scattered across the New Orleans metropolitan area. Like any wellness program, the value and effectiveness of the service is dependent on how it is adopted and used by those it is designed for and intended to serve. Known as the Greater New Orleans Community Health Connection (or GNOCHC), the system provides a range of services including primary and preventive care, substance abuse services, laboratory and radiology, immunizations, mental health services and more. The concept in this case is the same as for any wellness program – keep people healthy by preventing problems from occurring in the first place. In this way, the cost of health care can be contained, prescribed remedies can be most effective and the misery associated with illness can be minimized.

And so, after 10 years of effort the new physical infrastructure and service network is largely in place. Perhaps, as some still maintain, nothing can totally replace “Big Charity,” but the community health centers hold promise to be more practical and accessible.

New Orleans’ City Accelerator initiative focuses on raising awareness and participation in this citywide wellness program. The city selected a local nonprofit, 504HealthNet, to promote greater community acceptance through a marketing program, “Stand Up and Get Care.” In this week's in-their-own-words video (above), Ariel White, project coordinator for 504HealthNet, talks about how GNOCHC has emerged as an exciting and powerful support for low-income residents in a city with more than its fair share of health challenges.

The first phase of this effort took place at the end of 2015 and consisted of two elements: small group meetings and “Design Day” where participants recommended measures that would bring more individuals into primary care. More than 50 people attended Design Day and participated in two rounds of a co-design process. The first was an “easy win” design question that asked people what simple fixes the city could make to attract more program participants. The second was a "shoot the moon" opportunity for input, asking participants what intervention measures might consist of “in their wildest dreams.”

According to White, the ideas spanned a wide range of measures from implementing text message reminder programs, to producing health care awareness rap songs, to more aggressive advertising of the closest clinic locations, to publicly posting the cost scale. After all the recommendations were on the table, participants voted to create a priority list.

The top ideas were:

  • Providing free amenities at the clinics
  • Extending office hours
  • Better publicizing clinic location information
  • Ensuring faster appointments
  • Creating public service announcements
  • Outreaching to pre-existing neighborhood groups
  • Establishing better contact with cultural awareness groups
  • Publicizing success stories of the clinics and doctors
 
After Design Day, the core team met and refined the list of the most popular ideas. In a report summarizing the effort, Ariel White noted, “The result of Design Day is an outreach and education plan that will work to engage patients and get them into care through a variety of mediums from text messages to community organization partners, and a group of community advocates who will be willing to talk about health to their family and friends.” She concluded, "The community is looking for a place to go where they know they will be taken care of – and these places exist, we just need to build a better network of knowledge throughout the city."

After a long, difficult and sometimes divisive undertaking, New Orleans has created something new and potentially more applicable to the health needs of today and tomorrow. In its City Accelerator application video, New Orleans Mayor Mitch Landrieu said, “Today New Orleans is the nation's leading laboratory for social change.  We're testing innovative strategies to improve the lives of our citizens and setting an example that other cities can follow. … With the City Accelerator's help we can make a real difference for our city, our clinics and the people of New Orleans."

The plan is coming together.

 
 
Be part of the campaign for civic innovation at the City Accelerator, presented by Citi Foundation.