Samaritan Focuses on Community Health Needs

Your health shouldn’t depend on where you call home.

Access to health care, housing in safe neighborhoods, quality education and living‑wage jobs have the power to improve health outcomes.

It’s why each year Samaritan distributes Social Accountability grants to help local non‑profits identify and remove obstacles, including poverty and discrimination that affect communities and underserved populations. In 2022, $400,000 in Social Accountability grants were awarded.

Meanwhile, Samaritan programs, including the Homeless Resource Team, Samaritan Medical Group Geriatrics Medicine and Samaritan Care Hub, reach some of the most vulnerable people living in Benton, Lincoln and Linn counties.

“Access to health care presents a significant barrier in our region,” said Kristy Jessop, MD, senior medical director of primary care for Samaritan Medical Group.

Samaritan’s Population Health Services is using data to better understand community needs and address barriers, such as childcare, transportation, food or housing insecurity and
other challenges.

“We have a long way to go, but I’m excited by our growth and initiatives,” Dr. Jessop said.

Helping seniors live better

Medical advances have allowed people to live longer, and the geriatric population is growing. However, we’re not necessarily living better, said Maureen Bruns, MD, with Samaritan Medical Group Geriatric Medicine.

“There are people who are almost chronically hospitalized,” Dr. Bruns said.

Since 2015, a team of Samaritan geriatric specialists has ensured people living in residential facilities receive the best care without leaving home. Clinicians can respond around‑the‑clock to see patients in five senior residential facilities, including veterans, people recovering from serious illness or injury, those with memory conditions and people without family to look after them.

“Our patients are often very sick,” Dr. Bruns said. “By having a dedicated geriatrics team, we can avoid unnecessary hospitalizations and transports.”

Medical outreach extends care

People who are experiencing homelessness may be unable to do what they must to stay well. Those who have experienced trauma, are managing multiple health concerns or have complex diagnoses, such as diabetes or heart disease, and the elderly can be particularly at risk. Sometimes, people are hesitant to seek health care, including LGBTQ, black, indigenous and people of color.

Samaritan’s Homeless Outreach Team is a dedicated group of nurses, social workers and community health workers. The team visits clients wherever they are living, in tents, in
shelters, even in cars.

“We meet patients where they are, literally,” said Social Worker Anita Earl, who leads the Homeless Outreach Team.

The team receives referrals from hospitals and clinics to help people find housing, receive food, supplemental nutrition and transportation assistance and attend medical appointments if people are hesitant to go alone.

“We connect people to resources and services,” Earl said. “That can really make a difference in their lives.”

Collaboration includes clinics

Samaritan primary care clinics are being redesigned to deliver care more effectively. This includes screening for risk factors known as the social determinants of health, these are non‑medical issues which can impact a person’s health.

This information is available to an individual’s care team so they can help people solve problems, like what a person with diabetes can do if they don’t have a refrigerator to store insulin.

Stephanie Maxon, vice president of clinic operations at Samaritan, said the goal is to help people stay healthy.

“We want to catch them between the walking well and rising risk,” Maxon said.

That includes helping people avoid gaps in insurance coverage. Samaritan is becoming a community service partner with the Oregon Health Authority to sign up people directly for Medicaid insurance.

Samaritan has also added a new alcohol and drug counselor to meet with people newly diagnosed with substance use disorder. The counselor will contact people at the emergency department or clinics, informing them about services and resources available, and collaborating with primary care providers to establish a treatment plan.

“What we know is that people don’t always follow up on their own behalf,” Maxon said. “We can help them with this. We can do better.”