The reasons why are not a mystery. People suffering from mental illness are more likely than others to have severe medical conditions that are undertreated or untreated altogether.

Thanks to a grant from the Robert Wood Johnson Foundation, Matthews is embarking on a major study to determine how best to address the role of mental illness in physical health care.

The Health for Data Action Award will fund the study “Delivering Integrated Care for Individuals with Serious Mental Illness and Chronic Disease: Examining the Potential of FQHCs,” for which Matthews is the principal investigator. It will allow her and colleagues from Long Island University, the University of Pennsylvania, and New York University to analyze data collected from 1,462 federally qualified health centers (FQHCs). The data features anonymous information about the treatment of 6.3 million individuals between 2016 and 2021. Matthews and her colleagues will examine the data to determine which health centers served their clients best.

Like many of her colleagues in the Graduate School of Social Service, Matthews has focused her research on the ways that technology can be used to advance the field. This study also fits into her larger research agenda of promoting whole-person care for individuals with mental illness.

“There’s kind of an agreement that care is most effective when it’s integrated, which means care is systematically coordinated across disciplines and specialties,” she said.

“The problem is, there are lots of ways to deliver integrated care, and we don’t yet know which one is best for people who have co-occurring and chronic mental health needs.”

One of the most important way these health centers differ from each other is in the way they’re structured, she said. Centers that have coordinated care deliver mental health services and primary care in locations that are physically separate. Centers that have co-located care deliver all care in the same location.

Matthews said that the data, collected by the health care data warehouse firm OCHIN Advance, is extremely valuable because it pairs information about patients’ health outcomes with census data from the area.

“They merge patient-level data with information about the community and the clinic, so you can really understand not only what’s happening at the individual level, but the context in which they’re receiving their care,” she said.

“I think we’ll be able to understand in an innovative and comprehensive way what is working for this high-risk group, and why.”

“Delivering Integrated Care for Individuals with Serious Mental Illness and Chronic Disease: Examining the Potential of FQHCs”  began on Dec. 1 and will last a year. Matthews said she expects preliminary results in the summer and a final report in the late fall. Researchers will judge the success of the health centers using clinical quality indicators, such as whether a patient with diabetes is getting glucose readings on schedule. Health outcomes will play a factor as well. They’ll examine questions like, if a patient takes their medicine, does their condition actually improve?

The goal isn’t so much to decide which model of delivery is the best as it is to determine which one works best for a specific population. The general understanding in the field is that more integration is better and having a one-stop-shop where people can walk from their doctor’s office down to the hall to their psychiatrist is better and most effective.

“In some ways, I expect that to be true. However, I also appreciate that there’s a great amount of variation within this population that we’re calling individuals with serious mental illness,” Matthews said.

“There are many different diagnoses and clinical profiles within that group, so I do expect to see some variation that’s going to be really important for us to understand. We can’t just assume that a one-size-fits-all model is going to work for everybody with every type of mental illness.”

Ultimately, Matthews is hopeful that the study will shine a brighter light on the role that these federally qualified health centers play as centers for primary health care, not just places where people with severe mental illness get mental health treatment.

“It’s been the assumption that a group that has chronic mental needs must be treated in a mental health setting. I’m not convinced that that is true. There is little work that has looked at FHQCs in that way,” she said.

One area that the OCHIN data set does not address is how patients feel about their care. Matthews said the question of whether patients are happy and feel cared for is just as important as the two other factors and is an area she’d like to explore going forward.

“It’s hard to get data where get you everything all at one time because that requires more time-intensive work to get in touch with individuals and talk to them. It’s a different type of measurement that’s not always available in such a large aggregate form,” she said.

“The tradeoff is, we’re getting really generalizable results, which is something that is really valuable. It does give us somewhere to go next on this research.”

The two organizations signed a memorandum of understanding that commits to initiating several new programs.

“The partnership between Fordham and Northwell Health will be a boon for the University’s students and academic departments and a terrific resource for Northwell employees and researchers,” said Joseph M. McShane, S.J., president of Fordham.

“We believe the partnership will offer significant intellectual and policy cross-pollination between Northwell’s Center for Learning and Innovation, Fordham’s Graduate School of Social Service, the Gabelli School, and other schools and programs across the University, thus expanding Fordham’s curricular and programmatic breadth.”

The agreement will provide several benefits to both organizations. Northwell will lend its resources toward the development of Fordham curriculum, and in turn, the University will extend education opportunities to Northwell employees.

Enhancing Education Opportunities

As part of the agreement, staff at Northwell’s Center for Learning and Innovation (CLI), which functions as the health system’s in-house corporate university and serves as a teaching resource for the Zucker School of Medicine at Hofstra/Northwell, will work to enhance curriculum in Fordham programs.

Staff from CLI will work with faculty at Fordham’s Graduate School of Social Service (GSS) to develop course content for Fordham’s Master of Social Work (MSW) degree.

And in keeping with the patient safety simulation training and career development provided at Northwell’s CLI, the two organizations will create simulation-based training models for both GSS and Gabelli School of Business programs, including the University’s nonprofit leadership master’s program.

In exchange, Fordham and Northwell will explore the possibility of the health system’s employees earning certificates from GSS and other Fordham schools at Northwell facilities.

Defining the ‘Real Role’ of Social Work

For Northwell President and CEO Michael Dowling, GSS ’74, the partnership represents an opportunity for Northwell to expand the skills of caregivers in growing areas of the health care field. For instance, one of the industry’s needs, he said, is to provide additional training to social workers in managing the care of patients with complex needs.

“The partnership will help us define the real role of social work inside a health care system. We’ll be redefining the role of social workers, what functions they should take part in, and what leadership roles they should play,” he said.

“In many ways, it’s creating the talent for an evolving field of health care that is changing dramatically. You can’t have education moving one way and practitioners in the field moving in a different direction. You’ve got to be both moving in the same direction all the time.”

The connections between Dowling, Fordham, and Northwell go back four decades. After graduating from GSS, Dowling served as a professor of social policy and assistant dean there. In 2016, Dowling delivered the commencement address for the institute’s International Diploma in Humanitarian Assistance. He received a doctor of humane letters from Fordham in 2017, and this year, he joined the University’s Board of Trustees.

Strengthening Current Ties

Debra M. McPhee, Ph.D., dean of the Graduate School of Social Service, said the formal partnership represents a strengthening of an association that already exists. Students from GSS have done field placement work at Northwell facilities for several years.

“Michael Dowling is truly one of the most innovative guys I’ve ever met. He brings a social work perspective to his work in that he cares a great deal about relationships and focuses a great deal on investing in his people,” she said.

“As a result, he has created an incredible organization that is innovative in almost every part of its functions, from its medical school to its resources to its staff.”

In particular, McPhee said, she expects the MSW students in the graduate school’s Palliative Care Fellowship Program to benefit from the partnership. Graduates from that and other GSS programs have a firm grasp on the benefits of integrated health, which emphasizes the relationship between physical and psychological, or mental health, she said.

“One of the things that MSWs do well is interdisciplinary work. So as the health field changes, integrating more mental health and physical health, it’s a great place for social workers to bring their expertise to the table,” she said.

McPhee said GSS students will benefit from the partnership with Northwell because the faculty at the Center for Learning and Innovation has the ability to take a task and turn it on its head conceptually. For example, instead of traditional curriculum, she said, medicine there is reorganized into life stages, from infancy through death.

“The center is about engaged learning, hands-on applied learning through simulation, and observation, rather than through lecture. The folks running that center will talk in very different conceptual ways than say, a traditional academic institution, or other ways we teach,” she said.

Looking Ahead

As part of the agreement, Fordham and Northwell have also committed to exploring new initiatives in the future. The two will work to place more Fordham students in internships and fellowships at or through Northwell, and Northwell will also participate in Fordham’s annual STEM career fair. For Northwell employees, the University will explore the possibility of dedicated admissions services they can use to facilitate early applications both at the undergraduate and graduate level.

Benefits for faculty research will be discussed as well, with Northwell potentially sharing insights into health care-related topics with researchers such as those involved in the Palliative Care program and the Gabelli School of Business’ Global Healthcare Innovation Management Center. Discussions are also planned for possibly connecting Northwell employees to Fordham’s Master’s in Health Administration program, which is jointly administered by GSS, the Gabelli School, and the Graduate School of Arts and Sciences.

Dowling said he’s looking forward to future discussions that will reveal areas of cooperation that aren’t apparent right now, especially with other graduate schools such as Fordham Law.

“Health care is such a broad area, especially in an organization as big as ours. If you want to be in the finance business, we are a $13.4 billion organization with an enormous economic impact on the communities we serve. If you want to be in the IT business, we invest hundreds of millions of dollars annually in technology. If you want to be in the data information business, we’re responsible for storing, managing, and integrating millions of patient records,” he said.

“Fordham has all these programs on the academic side, and we’ve got all these programs on the ground level. So we want to examine how each of us can change so that we can help each other going forward.”

Harding, a native of Idaho who graduated from Fordham College at Rose Hill in 2018 with a degree in communication and media studies, said the film inspired to pursue her current career.

“I was interested in the power of positivity. I knew I didn’t want to do anything clinical; I don’t think I have the doctor personality in me. But I knew I wanted to help people, and I knew I wanted to work with kids,” she said.

As a care coordinator at the Memorial Sloan Kettering Cancer Center, Harding assists children who need procedures such as bone marrow biopsies. In that role, she said, she constantly utilizes the skills she learned as part of the inaugural cohort of Fordham’s master’s degree in health administration.

“In my department, I am trying to make sure our patients not only have a wonderful patient experience, but I’m also thinking of the procedures. In my department, I have to know what codes to use for billing, and I have to know the ethics behind the children going under anesthesia,” she said.

“All of these things are in the back of my mind while I’m at work, and I learned all of that through my introductory course to health care.” The course is one of 17 courses that comprise the program.

An Industry With Potential

As one of 17 students to sign up for the degree, which is hosted in the Graduate School of Arts and Sciences and taps the expertise of faculty from the across the university, Harding was exposed to all the facets of an industry that is estimated by the Center for Medicare and Medicaid Services to comprise more than one-sixth of the American economy.

It’s an industry that’s in great flux as well. On Sept. 10, the Census Bureau reported that about 27.5 million people, or 8.5 percent of the U.S. population, lacked health insurance for all of 2018, up from 7.9 percent the year before. It was the first increase in uninsured Americans since the Affordable Care Act passed in 2010.

Falguni Sen, Ph.D., a professor of business at the Gabelli School of Business who heads the program and the Gabelli School’s Global Healthcare Innovation Management Center, said that instability was exactly what the program was designed to address.

“Students told us the program really prepared them to address the challenges that the Affordable Care Act had brought into the health care industry, in terms of integrated care, the importance of prevention in primary care, and looking at the patient as a whole person,” he said.

“They’ve been given the tools where they can identify and create solutions to new problems as they come up.”

A Diverse Cohort

A second-year cohort has already admitted 19 students, and except for a small change to one course to help students better use data, the coursework is the same.

Although all students admitted to the program were required to show that they had a passion for the field consistent with the Jesuit tradition of service for others, Sen noted that differences among the members of the cohort were important too. Not everyone was a recent college graduate like Harding.

“We had members of the group who have been in the medical profession for more than 30 years. They shared information and opportunities with each other, and we see that reflected in the types of new jobs and promotions that these students have ended up getting,” he said.

Jeffrey Moskowitz, M.D., a medical review officer at Con Edison who earned a doctorate of medicine in 1977, was one of them. One of his previous jobs was as an administrator of a large outpatient surgery center, and he said he wanted to learn more about how larger trends in the health care field affected his work.

“My perspective on the field has totally changed. The only thing I knew was what I had personally seen. Here, we got a world viewpoint, which was much greater than anything I’d known before,” he said.

“This was an eye opener in terms of how things work on different levels—not just on a practitioner level, but the hospital level, the lab level, and how government policy affects everything.”

Focusing on Patients, Not Paperwork

For his capstone project, Dr. Moskowitz designed a wellness program for ConEd focused on preventing employees from getting sick. In terms of coursework, he noted that courses on marketing and ethics were particularly useful.

“We reviewed how to look at situations from various viewpoints and make reasonable decisions while keeping moral and ethical thoughts in mind, which is really what health care administration should be about,” he said.

“If the focus is the patient, and nothing is black and white, how do you best choose among the different options? I liked that ethics course a lot.”

And while it’s true that the Affordable Care Act has ceased to continually increase the number of Americans with health insurance, other changes that it inspired live on, he said.

“One of the modern revolutions in health care is actually listening to the patient. Traditionally health care revolved around what worked for the doctor, which is why most health care is delivered between 9 and 5, when it’s inconvenient for people to get there,” he said.

“Now many hospitals now have patient experience coordinators, and Medicare is reimbursing doctors based in part on patient surveys. This was all brought out in terms of the course.”

That renewed focus on patients is evident in the way the degree is structured, he said.

“As a Jesuit university, Fordham cares a lot about people,” he said.

“So it makes sense that this degree is about keeping people healthier, rather than just the simple administration of rules and regulations that help an institution make money.”

The answer lies in innovation, according to a group of industry experts who spoke at a May 7 event at Fordham’s Lincoln Center campus titled “Transforming Employer-Provided Health Plans: Innovating for Patient-Centered Value.”

Falguni Sen, director of Fordham’s Global Healthcare Innovation Management Center, which hosted the event, framed the extraordinary scale of the challenge in his introductory remarks.

“We are going to try to the impossible,” he said. “Making health care better than it is by changing the nature of both affordability and access.”

Rapidly rising health care costs have impacted health benefits in a number of ways that often leave both employers and employees dissatisfied, Sen said. This often results in narrower provider networks, more frequent billing, and recurrent claims disputes, among other issues.

“Employers want their employees to be healthy and their costs to be lower,” Sen said. “Employees want their employers to be successful, but not at the cost of lowering their health care benefits.”

Sen and an expert panel of health care industry leaders explored innovative ideas that will help achieve these twin goals during a wide-ranging discussion that drew heavily on the panelists’ real world application of novel and effective techniques.

Mitra Behroozi, executive director of Benefit and Pension Funds for 1199SEIU, the largest health care workers union in the U.S., illustrated how health care plans can harness “the power of zero” to deliver exceptional service at an exceptional value.

The nearly 400,000 members covered by the union’s benefit funds pay nothing toward their premiums and are responsible for no co-pays, coinsurance, or deductibles when following plan rules. But despite the extremely rich benefits enjoyed by members, the funds’ costs are well below both regional and national averages on a per worker basis.

Behroozi, who co-moderated the panel with Sen, explained that while some employers have directed rising costs to workers in the form of deductible and premium increases, the 1199SEIU Benefit Funds have taken an alternate approach.

“When you engage in extreme cost shifting, patients avoid needed care as well as unneeded care,” she said, continuing, “Our cost-containing principles are to maintain the availability of quality care and avoid financial barriers for our members.”

1199SEIU’s example demonstrates that quality benefits don’t necessarily have to come with high premiums and out-of-pocket expenses, she said, if plans are designed to incentivize choices that reduce overall costs.

“Our opportunity when we design benefits is to make it simple for people to use the highest-value things and to avoid the lowest-value things,” Behroozi said.

Claire Levitt, the deputy commissioner of the New York City Mayor’s Office of Labor Relations, shared her public sector perspective on how the city achieved $3.4 billion in health care cost savings that were used to fund wage increases for municipal employees.

One crucial step taken by the city, Levitt explained, was to begin collecting data on patient care costs, which had never been gathered before due to privacy concerns. Guided by this information, the city began adjusting beneficiaries’ out-of-pocket expenses to encourage preventive care and reduce the number of cost-driving visits to urgent care and emergency rooms.

Michael Chernew, the Leonard D. Schaeffer Professor of Health Care Policy at Harvard Medical School, drew on his experience both as a health economist and as chair of the university’s benefits committee. He noted that employers must consider not only insurance carriers’ costs, but also how the services available through their plans will accommodate employees’ needs. “You want to look for a carrier that can manage the care and has relationships with the delivery system,” Chernew said.

Tom Traylor, general manager of pharma solutions at the Health Transformation Alliance, explained how his company identifies high-value providers and treatments through data and analytics. The Health Transformation Alliance is owned by 50 blue-chip companies, each of which share health care data that can be leveraged to compare outcomes and produce better results for all of the 4.5 million individuals covered under the employers’ plans.

He detailed how thoughtfully constructed prescription drug formularies can drive patients toward high-efficacy drugs and exclude low-value, high-cost drugs.

“Just because the FDA approved it does not necessarily mean that it provides any additional value,” Traylor said. “You can have a drug that is one to two percent better or worse but 20 percent more expensive, and it’s in a category where there are drugs already available. Why have that drug available?”

While it is difficult to predict possible policy changes and technological developments that will help shape the future of American health care, Sen said, the innovations discussed by the panel will have a major role to play.

“In the next few years we are going to really see major changes in the way health care is delivered and paid for,” he said.

Sen quoted a remark his co-moderator Behroozi made to him about the task putting into motion the changes that will drive this transformation: “The main innovation lies in making innovation happen.”

— Michael Garofalo

“I would call people in other countries and say, ‘What’s your facility fee for an operating room’,” said Rosenthal, author of An American Sickness (Penguin Press, 2017). “And I’d hear this silence and they would go, ‘What do you mean a facility fee?’”

Rosenthal was the speaker at an April 18 talk and panel discussion organized by the Gabelli School’s Global Healthcare Innovation Management Center. She holds an M.D. degree from Harvard Medical School and currently works as the editor-in-chief of Kaiser Health News, a nonprofit news service that reports on the health care system. A former health care reporter for the New York Times, she is best known for her award-winning series on the costs of health care called “Paying Till It Hurts.” Through her research and conversations with patients, practitioners, and other health professionals, she said, she learned that medical concepts like facility fees are “uniquely American.”

According to Rosenthal, there are evidence-based studies about how medicine should be practiced in the U.S., yet economic incentives remains a top priority for many hospitals.

“We know what things work, but there is a lot of financial interests against them working,” Rosenthal said.

Cautionary Tales 

According to the Centers for Medicare & Medicaid Services, U.S. health care spending increased 4.3 percent in 2016 to reach $3.3 trillion. The agency projected that national health spending will grow at an average rate of 5.5 percent per year to reach $5.7 trillion by 2026.

In an age of hospital consolidations, Rosenthal said illnesses have become a form of commerce. This has led many Americans to seek alternative options in countries like Canada.

“That’s a sign of a broken system if there ever was one,” said Rosenthal.

One cautionary tale Rosenthal told was the story of a 28-year-old college student from Texas who was charged $17, 850 for a routine test that checked her urine for a host of things, unbeknownst to her, including opioids, amphetamines, and other classes of drugs.

“If you don’t ask these questions upfront, this could be you,” said Rosenthal. “That urine test was sent off to a lab that tested it for everything under the sun and it was out of network.”

Rosenthal said patients are often left with astronomical medical bills because they are billed by out-of-network medical assistants and other hospital staffers who treat them after surgery without their knowledge. Advances in treatment for conditions such as diabetes and astigmatism can also lead to increases in the costs of care. As hospitals became conglomerates, she said, they also began to look less like medical facilities and more like luxury hotels equipped with everything from indoor waterfalls to flat-screen TVs.

“We’re paying for amenities rather than care, and that, I think is a flaw of our system,” she said.

Though ambulance companies used to be volunteer-run and operated mostly by the fire department and local EMS more than 30 years ago, Rosenthal said they too have adopted a business model. According to Rosenthal, many ambulances charge by the mile and bill riders different rates based on whether they were treated by a paramedic or EMT. The ride can cost up to $2,000, she said.

Rosenthal said fees like these can be a burden for middle-class and lower-class patients who are struggling to make ends meet.

“If you don’t have a disposable income, the weight is infinite.”

Pushing Back at the System

Rosenthal believes many hospital facilities and physicians get away with unfairly charging patients for visits, exams, and procedures because patients often “scarily write checks” to avoid having their bills being sent to collection agencies.

“Medical bills are not like you made a choice where you know upfront what you’re paying for and you’re being delinquent,” she said. “It’s often [that]you didn’t know. You get these confusing bills and you’re trying to figure it out and that can take months.”

She encouraged patients to become proactive about health care by negotiating hospital bills; requesting itemized bills; asking for referrals to in-network physicians, labs, and facilities; and requesting estimates of tests and surgeries beforehand so there are fewer surprises.

“There is something that everyone can do to push back at the system,” she said.

Financially Rational Decisions

After her talk, Rosenthal was joined by internist Barney D. Newman, M.D., co-founder of WestMed Medical Group, and Mitra Behroozi, executive director of the 1199 SEIU Benefit and Pension Funds, a labor-management fund, for a panel discussion about the state of health care.

Behroozi explained that the decision to go to the doctor or the ER is still a difficult decision for many Americans.

“People will make financially rational decisions— especially if a $50 co-pay [at the ER]could mean the difference between being able to afford their transportation to go to work or not that week,” she said.

Newman noted that these economic strains are often the result of hospital CFOs and other finance personnel looking to generate high return on investment rather than being concerned about efficient clinical care. Still, he believes there are ways to use business to enhance the health care system.

“The consolidation of health care and the idea of applying business principles to health care is not all bad,” said Newman. “It has been focused on only the financial part of the outcome. There are actually a lot of opportunities to reduce cost in this country and improve quality by trying to apply classic business practices of quality management and continuous quality improvement to the process of care and how care is delivered.”

To answer the industry’s pressing need, Fordham has created a new multi-disciplinary master’s degree in health administration that will launch in fall 2018.

The degree taps expertise from across the University, including the Graduate School of Social Service and Fordham School of Law. Befitting that multidisciplinary approach, the degree program is hosted in the Graduate School of Arts and Sciences and headed by Falguni Sen, Ph.D., professor of business at the Gabelli School of Business.

“People are beginning to understand that health care is not something that is just owned by business, or regulatory services, or social service people, or by ethics experts,” said Sen, who heads the business school’s Global Healthcare Innovation Management Center. “It’s something that everyone has to come together to really deliver.”

Sen said the 12-month degree program is meant to appeal to the burgeoning field of mid-level practitioners with titles like care coordinator, case manager, hospitalist, physician assistant, information technology assistant, nurse practitioner or medical entrepreneur.

The field is also drawing liberal arts undergraduates looking to join a growing sector of the economy. “They may never have to create a balance sheet but since they’ll be tasked with putting into action many of the changes under health care reforms, it’s important that they’re able to read one,” Sen said.

That’s because even though the industry has embraced “patient-centric care,” it still operates from a surplus-generating business model, he said. Those two models—one focused on doing whatever it takes to keep a person healthy and another with an eye on the bottom line—need to be balanced delicately.

“Ideally, we can achieve proper health care if we can bring together the clinical model and the business model to focus on patient centric care” Sen said.

“This master’s degree will help you understand how to make your organization work for both of these models.”

Of the 14 courses required for the degree, nine are brand new. They include Strategy and Operations in Health Care, Behavior Health, Patient-Centric Care, Population Health, Public Health and Outcome Measures, and Negotiating and Communicating in Health Care.

In the growing field of electronic health records, Sen hopes the new master’s degree will close training gaps among longer-term health care workers.

“We’re not going to make people IT experts or teach them how to create new systems, but we can teach them how to use the systems properly and not be intimidated by them,” he said.

Sen said that other big shifts are underway in the field. Health care companies are looking to increase ways to measure patient satisfaction. They are moving toward “value-based payments,” in which insurers place a higher premium on the quality of treatments over quantity. And they are improving transitional care, which takes into account how patients fare when they return home or their community or are moved to nursing or long-term care .

“These changes are here to stay, and I don’t see anything in the new plans being debated in Washington that will stop them,” Sen said.

“Will we have a greater number of uninsured people who will put a serious strain on hospitals? That’s a possibility, and those are serious issues that are being debated. But these administrators will be in demand and expected to perform.”

New research from the Gabelli School of Business suggests that a deeper understanding of the role that financial exclusion plays in health care can help health care providers to better market programs that serve disadvantaged populations.

“Health care is a service that requires financial planning,” said Genevieve O’Connor, assistant professor of marketing at the Gabelli School. “Those who are financially excluded don’t have the resources to access services that meet their needs, which creates a barrier to care.”

Using data from a major metropolitan hospital in New Jersey, O’Connor studied how insurance and income enable use of health care services, and how this varies among millennials, Generation X, baby boomers, and the Silent Generation. She also measured utilization across gender and ethnic lines.

Her research, which was published in the Journal of Financial Services Marketing earlier this spring, showed that various groups and populations used insurance differently. While insured customers of all generations used less services, she learned that Asians, and other ethnicities of the Silent Generation used fewer services than whites—both insured and uninsured—of the same generation.

Conversely, while these non-white groups in the Silent Generation used fewer services, African-Americans in Generation X, for example, used health care much more—even as Generation X whites were using health care services less. A similar pattern was observed among Asian-Americans.

O’Connor’s findings suggested that cultural and generational life experiences may shape a person’s behavior or attitude toward health care.

Since studies have shown that immigrant populations such as Hispanics, and younger generations such as millennials, harbor a distrust of banks and banking, O’Connor wondered if the same thing was happening with health care, and if financial exclusion was a key factor.

“We typically think of financial exclusion as a lack of financial services,” she said. She explained that individuals who are “unbanked” are typically women, the poor, ethnic minorities, elderly, single parents, the unemployed, students, and people living in rural communities. “But those who lack access to financial services are the same people who lack access to health care.”

O’Connor said financial literacy impacts decision-making, including understanding how the use of health care services affects well-being. Also, complex health care terminologies such as premium, deductible, HMO and PPO, can be challenging to comprehend— even for educated consumers.

“Just because insurance is offered, that doesn’t necessarily mean most people will use it,” said O’Connor. “This is where marketing comes into play.”

In situations where the mere fact of having health insurance doesn’t lead individuals to use health care services, O’Connor said personalization of the marketing message is instrumental.

“It’s about getting into the mindset of those consumers,” she said. “Maybe there’s a shared experience that they have that we can tap into, even from an environmental perspective, to see how they might be more amenable to using those services.”