• Social Services: Prescribing the Basics of Good Health

    An interview with Rebecca Onie Jun 10, 2013

    Physicians often wish that, in addition to medicine, they could offer other essentials to their patients—like food, utilities, and a job. This entrepreneur has created a way to make that happen.

    Rebecca Onie


    When a family brought their three year old to Harriet Lane Clinic at Johns Hopkins Medical Center to be treated for an asthma attack, they got more than an inhaler. 

    By examining both the child and his home life, the pediatrician learned that the family lived in an overcrowded apartment with too little food and no utilities. In addition to medicine, the physician prescribed basic services that the family needed to maintain good health. An advocate from Health Leads—a not-for-profit organization that has a help desk at Harriet Lane—then connected the family with health insurance, financial assistance for heat and utilities, and a job training program for the child’s mother.

    Similar situations played out nearly 9,000 times last year, as Health Leads served patients and their families through more than 20 pediatric and prenatal clinics, newborn nurseries, emergency departments (EDs), and community health centers in Boston, Baltimore, Chicago, and three other cities. 

    “Patients’ social needs have historically been viewed as peripheral,” says Rebecca Onie, Health Leads’ co-founder and CEO. “What Health Leads does is systematically make them integral, in a relatively seamless way, to the healthcare delivery that’s provided in clinical settings.”

    How It Works

    Health Leads, which was founded in 1996 as a student-run organization, recruits, trains, and supports student volunteers from Johns Hopkins University, the University of Chicago, and other schools to serve as advocates for patients and families who need help accessing resources. “This untapped workforce of energetic, extremely capable, well-trained, and tenacious student advocates keeps Health Leads’ costs low while giving students an opportunity to gain insights they might never learn elsewhere,” says Onie. 

    The ROI

    In most communities in which Health Leads works, a health system pays part or all of the program costs because its leaders recognize the need—and the benefit. For example, research has found that pediatric patients whose families cannot pay their utility bills are 30 percent more likely to be hospitalized. So every time Health Leads connects a patient to needed resources, it may be reducing utilization.

    “Despite the complexity of the patient population that we focus on, 70 percent of the patients with whom we worked last year were successfully connected to at least one resource that they needed, or they were given the information they needed to connect with the resources themselves, according to their wishes,” Onie says.

    Health Leads is currently working with several of its current partners, including Children’s National Medical Center in Washington, D.C., and Chicago Family Health Center to measure the effect of its work in improving primary care utilization, decreasing ED utilization, and increasing patient satisfaction.

    An Idea that Grew...and Grew

    Onie was a sophomore at Harvard College when she founded Health Leads—originally called Project HEALTH—with a Boston pediatrician. She oversaw expansion to Providence and New York City before attending Harvard Law School and beginning her legal career.

    Since returning to Health Leads full-time in 2006, Onie has become one of the most celebrated young executives in health care. Among other accolades, she received a MacArthur Fellowship, often called a “genius grant,” and a John F. Kennedy New Frontier Award. That probably reflects the fact that the idea she had in the mid-90s—poverty is a health determinant that must be addressed—has become clear to leaders within health care and beyond.

    Indeed, Health Leads last year received nearly 600 requests to expand into additional locations. Although her organization is planning for a period of rapid growth, Onie’s first priority is to spread the idea that medical care cannot be effectively delivered in a vacuum.

    “Our ultimate goal is to move to a system where basic needs are routinely addressed as a standard part of patient care—not just through Health Leads but also by catalyzing others to pursue alternative models as well, says Onie.

    Rebecca Onie, JD, is CEO, Health Leads, Boston.