Dust mites feed on molds and organic detritus. Their feces (greenish spots) induce allergenic reactions. Glossy brown spheres are their eggs.
Dust mites feed on molds (green) and organic detritus. Their feces (greenish spots) induce allergic reactions. The glossy brown spheres are their eggs. Allergen removal is part of an in-home initiative to reduce asthma triggers. (For Spectrum Health Beat)

Gloria lives with her family on the southeast side of Grand Rapids. Her 2-year-old grandson and 10-year-old granddaughter both have asthma.

Healthy Homes Coalition of West Michigan met Gloria when canvassing her neighborhood as part of another asthma remediation project.

Through the program, Gloria learned strategies such as using green cleaning supplies, changing furnace filters regularly and using a HEPA vacuum. Gloria’s husband removed the carpet on the stairs to reduce dust mites in their home, and new pillow and mattress covers also helped reduce her grandchildren’s exposure to asthma triggers in their home.

“Before Healthy Homes came, we didn’t know what triggers caused symptoms, like the cleaning products and the dust mites in the carpet,” Gloria said. “It has been helpful to understand there’s more that I can do than just give him his inhaler.”

Gloria is among the many families who will be helped thanks to a public-private partnership hatched by asking this one question: What if you could address a public health need by asking private investors to put money into solving an underlying social problem?

Pay for Success, a program of the Social Innovation Fund, is an innovative public-private partnership that does just that by leveraging private investment dollars to achieve sustainable public health outcomes.

Here’s how it works: A private investor provides funding to finance nonprofit service delivery that benefits a health care entity, such as a local hospital or health insurance plan. If the services provided achieve agreed-upon outcomes, the health care entity repays the investors. If the outcomes are not achieved, the public entity does not pay.

A major, unmet public health need in this country is the problem of asthma, the focus of projects in five communities recently selected for funding by the Green & Healthy Homes Initiative and the Calvert Foundation.

“Research shows that 40 percent of asthma episodes are caused by home-based environmental health hazards,” said Ruth Ann Norton, president and CEO of the initiative. “Much of this cost is born by medical and federal taxpayer dollars, yet these programs provide little to no resources to eradicate the root causes of asthma.”

“We spend a great deal of money each year addressing emergency care, acute hospitalizations and the management of asthma, yet, as a society we have not really addressed the root causes and triggers of asthma,” said Kenneth J.  Fawcett, MD, vice president of Spectrum Health’s Healthier Communities. “This program provides the chance to address these causes.”

Grand Rapids, Michigan, is the beneficiary of one of the five community grants, along with projects in communities in New York, Tennessee, Utah and Massachusetts.

In Grand Rapids, Spectrum Health and Priority Health are working in collaboration with Health Net, Asthma Network and Healthy Homes Coalition of West Michigan to conduct feasibility studies to fund home-based asthma interventions, including remediation of asthma triggers and resident education.

Anticipated project outcomes include reduced asthma-related hospitalizations, reduced emergency department visits, and ultimately, reduced health care costs.

“This is a tremendous opportunity to make sure substandard housing does not result in children going to the hospital in West Michigan,” said Paul Haan, executive director, Healthy Homes Coalition of West Michigan. “This project will make kids’ houses healthier, and the financing strategy makes this work truly sustainable.”

Another societal impact of the disease, Haan added, can be felt in the high rate of school absenteeism for students afflicted with asthma.

“It is vital to keep kids in school,” said Haan. “Asthmatic kids miss a tremendous amount of class time and studies show that attendance issues are particularly pronounced in grades K to 3.”

“We have long recognized that access to high quality health care is not the sole determinant of health,” said  John L. Fox, MD, associate vice president of medical affairs at Priority Health. “Environmental factors, socioeconomic factors and others play important roles.”

“Priority Health, with the help of private investors and community partners, is widening its efforts to improve health by tackling those physical and environmental factors that impact pediatric asthma patients in particular,” Dr. Fox said. “And it’s a win-win for everyone involved. If we are able to improve a child’s health through home renovations thereby reducing emergency room encounters and hospitalizations, then Priority Health experiences lower costs and in turn uses those savings to reimburse the private investors.”

Officials expect the feasibility study to take from six to 12 months. The project may impact more than 200 families in West Michigan in its early phases.

“It’s less about the numbers served, and more about developing a truly sustainable business model where investors are attracted by both return on investment and their ability to make a significant impact on a social problem,” Haan said. “Our job is to figure out the sweet spot.”

Dr. Fawcett emphasized that, unlike federal grants that fund a finite sum and expire after three to five years, these projects are designed to be self-sustaining.

“We just have to get the rock rolling and it will continue to provide sustainable benefits going forward,” added Dr. Fawcett, who noted that project leaders are looking to recruit investors from both inside and outside the region. “This project will benefit the children of today and the children of tomorrow.”