Thinking Out of the Mailbox: A New Model for Health Care Delivery?
When it comes to solving health care delivery problems, who would think of the postal service as a potential source of solutions? Yet, a pilot program in Jersey, an island between France and England, has shown that this entrenched institution offered a creative way to provide care to a group of people who are among the most difficult to reach – the frail elderly.
Although the pilot didn’t seek to provide a substitute for health and social care professionals, this group did exhibit some territorial defensiveness, with little active participation by incumbent providers.
From 2010 to 2040, the number of islanders over 65 in Jersey is predicted to double. However, Jersey’s health system suffers from outdated models of health care delivery. Meanwhile, the postal system, a government-owned organization with 400 employees, has been exploring alternatives to diversify its business due to the global decline in people sending paper-based mail.
When the Jersey Post ran a competition asking employees what other services they could provide, the winning proposal suggested expanding the role of postal workers to regularly check on isolated and frail elderly people and provide such support as organizing shopping delivery and dropping off medications. In November 2013, Jersey Post funded a pilot program named “Call & Check” with 25 clients initially enrolled. Clients selected the days on which they would receive a visit from their postal worker. The workers made about two visits per week, which ended up lasting less than five minutes, at a cost of $6.33. Postal worker training included a basic overview of how the service operates and a basic list of “things to look out for.” To ensure safety, the postal workers did not cross the threshold of people’s homes, and the service did not go beyond checking, reminders, and making referrals; no formal “care” was provided. Where indicated, the scheme included picking up prescriptions and dropping off repeat medications.
An informal qualitative evaluation revealed that all participating clients received significant benefit and support from the scheme. In addition, those delivering the service stated that it gave them added job satisfaction. However, Call & Check did face some challenges. Although the pilot didn’t seek to provide a substitute for health and social care professionals, this group did exhibit some territorial defensiveness, with little active participation by incumbent providers. The main prospective challenge now lies in liberating calcified funding streams to expand the scheme.
This model would benefit elderly people and their caregivers, as well as provide an alternative sustainable revenue stream for the US Postal Service.
Consequently, there are plans to develop a cloud-based technology platform that accesses clients’ medical records, enabling postal workers to check upcoming health care appointments.
US postal and health care delivery systems need similar innovation
Could it work here? Like the UK, the US health system is struggling to meet the health and social care needs of the growing proportion of citizens over 65 – and the US Postal Service ended its second quarter in 2014 with a net loss of $1.9 billion. Lawmakers are reluctant to see postal services reduced, and plans for postal reforms have stalled. The place to start may be with a countywide approach that pilots a cross-sector innovation between the health care industry and the postal service, with funding from the Centers for Medicare and Medicaid Services, philanthropy, and the US Postal Service. This model would benefit elderly people and their caregivers, as well as provide an alternative sustainable revenue stream for the US Postal Service.
While no single innovation will address all the needs of older adults, the Jersey Post reminds policymakers to think out of the mailbox when it comes to potential solutions to improving the delivery of health care.