How can tires improve health?

Using county funds dedicated to community health, the United Way purchased two tires for the woman — and a south-side discount tire shop pitched in, offering the other two for free.

“It was really a community effort,” said Victoria Perez, who works at United Way.

The nonprofit is one of many organizations participating in the year-old Santa Fe County Accountable Health Community, a network of health and community service providers that coordinate their efforts to ensure county residents have access to everything they need for their health and well-being — not just direct health care, but also things such as food and food aid, housing, employment and transportation.

The U.S. Centers for Disease Control and Prevention has found that things like economic stability, education and home and work environments — known as social determinants of health — can affect a wide range of health outcomes.

“There is a growing realization that the social determinants of health really are health care,” said Rachel O’Connor, Santa Fe County’s director of health and human services. “We can’t be healthy unless we have money for food, housing … all of those things that give us a foundation for life,” she said.

Kyra Ochoa, a county health care assistance program manager, said the initiative, which aims to build a healthier community and to reduce long-term costs to local health care systems, is “really to try to create a health and human services system which is stronger than what we had, which was not as connected as it needed to be.”

Several areas around the country, such as regions in Washington state, have implemented similar models to improve access to social services. The U.S. Centers for Medicare and Medicaid Services sponsors more than 30 such Accountable Health Community initiatives, including one in Albuquerque.

Santa Fe County launched its effort in December 2016.

Ochoa describes the Accountable Health Community as a reframing of what the county already does. Local groups continue serving the community in the ways they always have. The county still gives funding to local health and human services groups that help achieve county goals, like reducing the suicide rate and increasing healthy food consumption. But under the Accountable Health System, the county facilitates communication and interaction between these agencies, building a network of these providers and helping groups more efficiently serve the county residents who need their help.

A pivotal part of the effort was hiring county-funded “navigators,” who work at different agencies, like La Familia Medical Center and the Interfaith Community Shelter, to help people connect with services they need — not just at one agency, but whatever services they might need around the county.

In the first quarter of operation, navigators helped 83 people access services, according to data compiled by the county. The project was awarded $3.3 million from the Santa Fe County Commission for three years, O’Connor said, through fiscal year 2019. For fiscal year 2017, the project budget was $1.7 million.

Through the county’s model, these navigators and partners also are encouraged to help determine how the program can best meet community needs. In fact, almost two dozen agencies, from the city of Santa Fe Community Services to Presbyterian Medical Services, make up an advisory committee that helps influence Accountable Health Community decisions.

That’s how the funds that paid for the student and caregiver’s tires came to be. While the county long has provided grant funding and contracts to community agencies that serve local people, many of those nonprofits have said they need access to more flexible funding to help with unexpected costs that arise, such as buying emergency baby formula for a new mother or helping to pay certification fees for people trying to re-enter the workforce.

Under the Accountable Health Community model, there is extra money for those types of needs.

“We’re listening to them and trying to give them what they need,” Ochoa said. “I think it’s symbolic of a ground-up approach to some of this work.”

Moving into year two of the project, organizers plan to install an information technology system to help organizations streamline their information.

During an evaluation phase, leaders of the initiative will measure and track whether this effort is really making a difference for county residents. The cost of the evaluation was built into the project’s funding, O’Connor said, and the county plans to contract with an outside firm to evaluate and establish a framework for ongoing review.

At a meeting in mid-December, leaders from local homeless shelters, representatives of the Santa Fe County Fire Department and county jail, and staff from nonprofits such as the food delivery service Kitchen Angels and conglomerates like Christus St. Vincent Regional Medical Center gathered to discuss the project’s first year and plan for its future.

Carol Luna-Anderson, executive director of The Life Link and chairwoman of the advisory committee, told them that their willingness to learn from county residents and to work with one another to serve local people is what will make an impact on the community.

“We have had a lot of studies done,” Luna-Anderson said. “We’ve had a lot of gap analyses. We’ve had a lot of, ‘Let’s look at the social determinants [of health], let’s look at all of it,’ … but then what?

“I think,” she added, “that this has been the ‘then what.’ ”

Contact Sami Edge at 505-986-3055 or sedge@sfnewmexican.com.