Michael Horne believes no one should be left out of health care

Michael Horne is the President and CEO of the Parkland Foundation at Parkland Hospital, a public hospital specializing in the belief that no one should be left out of care.

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George Mason:
Welcome to Good God, conversations that matter about faith and public life. I am your host, George Mason. I'm so glad to welcome to the program in this series on poverty and its alleviation in our communities, the president and CEO of the Parkland Foundation in Dallas, Texas, Michael Horne. Michael, we're so glad to have you here.

Michael Horne:
Thank you so much for this opportunity. I'm glad to be here.

George Mason:
Great. So tell everybody a little bit about the Parkland Foundation. Now you came to this job from being in Dallas, you were working with charter schools, the KIPP schools, and mostly in South Dallas and more disadvantaged neighborhoods and that sort of thing, so you had worked with people who have experienced poverty before. This kind of work is a bit of an extension of that, isn't' it?

Michael Horne:
It really is. My life's work has been oriented towards the social enterprise space, creating conditions in which individuals and communities can realize their full promise and potential. Did that on the education side. But I would say healthcare similarly is an avenue and certainly a context in which it's really important that communities have access to the type of care they need to realize their full promise and potential. And so the foundation at Parkland exists to raise awareness and philanthropic support to really accelerate the work of the hospital. And most recently our focus has really been increasing access to care as a critical way to address longstanding and persistent health disparities that we know have been in place for decades throughout Dallas County.

George Mason:
Well, let's talk about those disparities, but before we get to that, I think it would be helpful probably for people ... everyone doesn't understand the distinctions among types of hospitals providing healthcare in a community. Can you sort of enumerate those for us and where Parkland fits in that ecology?

Michael Horne:
Yeah certainly. Parkland Hospital is a public hospital system. Specifically what that means is that I would say a substantial portion of funding that Parkland receives is derived from government funding. Specifically, if we just look at the last fiscal year, so FY19, about 48% of our revenue came from what we say patient services, 29% were derived from property taxes, as a public entity at about 13% from government programs. The sources of revenue really center around funding that we receive as a public entity to ultimately support the service delivery model that we have.

Michael Horne:
There are other certainly systems. Private systems that often rely more heavily on a different type of payer mix in terms of the revenue that they receive as well as faith-based hospital systems that certainly have a mission, and I would say programmatic orientation really guided by a spiritual or religious kind of ethos. While that is not necessarily the focus of Parkland, I would be remiss in not saying that our mission being dedicated to the health and wellbeing of individuals and communities entrusted to our care and even how we live that out, is very much focused on the idea of empathy, of compassion, of service. I think principles that we would say are certainly spiritually related or humanistic.

Michael Horne:
I do want to make the clear distinction, but also recognize that even a system such as Parkland, the idea of spiritual care is definitely rooted in how we see the types of service that we provide to those in the community particularly those who are most vulnerable.

George Mason:
Those who are most vulnerable is part of where I think that connection is made because people of faith tend to start with this idea that true faith is validated you might say by whether we are taking care of, as the scripture says, the least of these, our brothers and sisters. That is those who are hungry and thirsty, those who are sick, those who are in prison, those who are in need. And so as a society, if we only commodified healthcare, if we only made it something that people could get if they could afford to pay for it, then we would be failing in that regard because there's so many people who would not be able to afford their care. And so a public hospital has a kind of mandate to serve everyone, doesn't it?

Michael Horne:
It really does, and that is a key distinction for Parkland as a public hospital system. I think what it does is it also elevates the tension, frankly, that exists at a macro level in the broader kind of public health and health space, and that is we recognize that costs increase, we recognize that our reimbursement kind of a system is oriented in some ways to preference a type of patient. What we are aiming to do at Parkland is to really create an environment, an ecosystem in which irrespective of your zip code, irrespective of your social economic status we truly believe that you should still have access to high quality and compassionate care. And I would submit that if we take that a little further and that is to say, if we actually create a space in which individuals irrespective of zip code and background have access to high quality care, we actually from an economic standpoint can really kind of shift the kind of two tier system that we often find ourselves in and which the haves continue to progress and the have nots do not.

Michael Horne:
If we get to this beloved community that I know Dr. King and others spoke of I think public institutions like at Parkland really are the epicenter of how we are reframing and re-imagining the type of public institutions that need to be at the core of how we operate as a society rooted in those principles of service, those principles of inclusivity and certainly equity.

George Mason:
So we have a society that on the one hand really favors a kind of free enterprise economic marketplace, you might say, that has insurance companies and insurance that comes often through your employer, and then of course we have the Affordable Care Act where you can buy into this insurance and often have it subsidized, but there are many people without any insurance. Parkland is a place where people go, and actually Parkland even goes beyond its own place. It goes into communities deliver healthcare and clinics and community-based clinics too. So would you say that Parkland really specializes in a sense in making sure that no one is left out of care? That's actually something ... not to denigrate other hospitals because they have certain mandates as well for the public health, but Parkland is the sort of go-to place you might say, isn't it?

Michael Horne:
I would agree. I think to your last point, the complexity of the challenge and opportunities that we see in the healthcare space and just the social space in general is such that we need the constellation of actors and stakeholders really driving the work forward. Parkland has existed since 1894 under the understanding that it would really need to bring the care to the patient. We are certainly grateful for the tremendous outpouring of support from Dallas County taxpayers, and certainly the broader philanthropic community locally and abroad that invested in what we call New Parkland, our New Parkland campus, and certainly having that new space, what allows us to do on a day-to-day basis, and even now, as we are still confronting this global pandemic.

Michael Horne:
With that being said, we also know that for many of our patients, we find that they are caught in this really dangerous calculus, and that is making a decision to either accept or forgo care because of the real life barriers to even getting to their appointment. And that is do I take off of work or do I take several Dart buses to get to the hospital, and in doing so I get docked my pay and I can't pay for food or childcare. And so our response increasingly has been, we really need to go to the community.

Michael Horne:
When I think about again, this idea as a metaphor of ministry, certainly it is to step outside the walls. We have to do that increasingly, recognizing that everyone is positioned differently where they are and the barriers may be different. However, our response has to be such that we can continue to dismantle those barriers that may really be, and in many cases life and death, as it pertains to the ability for patients to gain access to the type of care that they increasingly need.

George Mason:
You mentioned the New Parkland facility. If people in Dallas County have not visited the New Parkland, they would be amazed at that extraordinary building. I mean, I've been here long enough to have remembered the old Parkland, of course. And there was an older Parkland before that, as a matter of fact. It's been turned into a beautiful office complex now. This New Parkland is state-of-the-art. What was it? $1.2 billion or something like that?

Michael Horne:
Yes. Yeah it was. The foundation played a critical role raising $150 million to really support the development of our new campus. When I walk the halls, one of the things that really is striking beyond the aesthetics, and certainly from an architectural engineering standpoint the intentionality and design is really the ways in which Parkland has brought to life a core value of dignity. And that is, I think for many individuals, particularly in the healthcare space and especially, I would say in engaging with vulnerable communities, there's this misconception that the ability for someone to pay or not pay then dictates the type of care that they should receive and even the environment in which they should receive that care. And we've kind of flipped that to say, no. Actually we believe that everyone should have access to state-of-the-art technologies, comfortable spaces, the opportunity for natural light to come in, because we actually know the impact is well-documented that that physical environments have on health and wellbeing.

Michael Horne:
The ability to bring together and bring to bear all of those elements in a facility is remarkable and is something that I don't lose sight of when I'm in the hospital.

George Mason:
Great. Well, it is a beautiful thing. I think anyone who goes there for care would sense the extraordinary care that went into making it up, in making sure that everybody has an opportunity not only to basic care, but to all the other things that go into bringing about health and including the fact that Parkland is involved in initiatives, as you say, to prevent illness too. This is a big part of what's going on right now in healthcare that drives people into poverty is that if people who are poor get sick, then there is a spiral down that happens for them in their families. Can you say a few words about that phenomenon?

Michael Horne:
Yeah. What we have found most recently in an assessment of healthcare challenges, called the Community Health Needs Assessment, and this was a report or study that was done between Parkland Hospital and the Dallas County Health and Human Services Department, was really to bring to light some of the challenges that exists. And I would say at its core is this idea that for far too many residents of Dallas County, the inability to receive the care, and I would say care that's more focused on upstream healthcare opportunities, the preventative measures, certainly managing healthcare really in promoting certainly the prevention of diseases, for many individuals they are certainly not unfortunately positioned in the system such as that is the main orientation that they have. What then happens is certainly the individual suffers, and then those who are connected to the individual, whether be families and whole communities, certainly suffer.

Michael Horne:
So what we've tried to do and we've done is one, first kind of bring a greater level of transparency to those challenges that exist. There are a couple. One, we know that if we look at Dallas County, about 78% of Dallas County residents are insured. That 70% is compared to about 82% of Texans and 90% of individuals across the United States. Within those slices, if you will, 64% of Latin X individuals across Dallas County have access to insurance. And that is the lowest rate for racial ethnic groups across Dallas County. And so certainly just accessing care is a challenge that we continue to confront.

Michael Horne:
What that then means is those are the populations that increasingly are most vulnerable. Confronting a series of mortality and morbidity factors, whether it be heart disease, hypertension, late stage breast cancer diagnoses, pediatric asthma, particularly I would say for Latin X and African American communities across Dallas County. And then if we zoom in, there are a series of neighborhoods and communities on the southern belt that are disproportionately being impacted as it relates to those diseases that I mentioned.

Michael Horne:
The first step we have to really bring to light what is actually happening. The second thing that we then did is we said, well identifying the challenge is certainly only part of this solution. We've got to then have a plan to respond. Our community health needs assessment implementation plan is really oriented towards advancing a series of initiatives rooted in this belief that if we address healthcare disparities, but do so in a way that improves access to care, that highlights and promotes disease prevention, and certainly puts into motion more preventative measures, that we then will lead to a place where the overall health quotient of Dallas County will increase, more and more individuals will actually be in a position from economic standpoint to contribute in the ways that they want to contribute, but have been prevented based on their health condition for far too long.

Michael Horne:
We're doing things like increasing health centers, bringing a center to Redbird, expanding our operation in Vickery, thinking more about virtual care. Since the pandemic, we've seen an exponential growth in patients who are accessing care virtually, whether it be through the telephone or through platforms like we're doing now, virtually with Zoom. That certainly allows for greater conductivity, as well as reduces some of the challenges that we see where individuals may not be able to actually physically get to their appointments. Now, with that also comes a recognition that for many patients and individuals across Dallas County, there's a broadband internet gap. And so we have to also work on the built environment. We necessarily can't do that alone, but we can work in partnership with other organizations to transform the environment in which things such as virtual care can be offered.

Michael Horne:
That's the second piece. The third thing I will say is there is an intersectionality. Like in most things between health outcomes and other social determinants of health, which is to say, if we can ensure that more and more individuals, particularly those who are disproportionately at risk for diseases such as diabetes or hypertension have access to healthier foods, have better transportation opportunities, certainly our position from a workforce standpoint to gain a job with livable wage, if we can start to connect those dots, then individuals are more likely to certainly be in a position ultimately to be healthier, especially if there are caregivers to then provide for their environment. And so we start to see this kind of knockoff effect over time where children are going through the continuum in a space where they can grow up and mature in a much healthier fashion and manner.

Michael Horne:
Parkland is trying to really kind of focus on how do we start to re-imagine the healthcare delivery system in a different way, and do so in a way that is data informed, that certainly identifies the needs of our patients, brings care to them rooted in the community, but ultimately then recognizes that we are stronger together. And so partnering with other community-based organizations can allow us to develop solutions that we believe are born out of the needs and desires of the community, as opposed to us parachuting in and dictating what we believe needs to be done.

George Mason:
Michael, I think that if people are listening to this, they probably would have a strong sense of surprise at how broad you are talking about your work. Because I think most people who hear that we're going to talk to the president and CEO of a hospital foundation, assume that we're going to be talking about the need for philanthropy, that you're out there raising money, and your whole job is to raise money for another machine in the hospital or for some expanded wing that will be named after some rich person. And here you are doing a real community-based analysis, a social analysis of what's needed, and not just making a pitch for money. Although the money follows the mission, right?

Michael Horne:
Of course.

George Mason:
We understand that part of it. I think what we're aiming in this whole series on poverty is to help people realize that there's not one solution to poverty; it is, as you say, this enormous constellation of things. We're talking about education and the zip code you live in and the amount of family income that you have and the access to good healthy foods and the kind of housing that you have and transportation, all of these things come together and they're sort of taken for granted by people who live say where I do. I think you and I talked about this at one point, I'm trying to remember the numbers. Maybe you can help me. The life expectancy of people who live from one part of Dallas to the next decreases by two years per every mile or something. What is that number?

Michael Horne:
Yes. Yeah, it's about 1.5 years. Essentially we simply just focus on south versus north is about a 23 year average variance in life expectancy. This is 2020, so it's unfathomable to think that we're facing this.

George Mason:
Yeah and we don't realize that. Of course 84% of the tax base in Dallas is north of the Trinity River. So we do have an enormous sense of inequity in Dallas. You and I have talked offline about this. Last week we presented the really great news that our parent organization of Good God Faith Commons has been able to contribute to the alleviation of poverty and whatnot because of medical debt. I want to reiterate that and have you comment on it a bit. We were because of a grant to us, able to work with a group called RIP Medical Debt. We were able to expunge and completely eliminate more than $4 million worth of personal medical debt that people were carrying in Dallas County alone, largely in disadvantaged communities. That has, I'm sure, a jubilee affect in people's lives, don't you think?

Michael Horne:
It really does. Medical debt, like a lot of debt, certainly shackles individuals and families. It really impedes their ability to seek the kind of holistic care and wellness that they're looking for, and really becomes almost a form of trauma, I would say as you are facing spiraling effects of debt, eviction, et cetera. And so I think initiatives such as what you've described are needed. We need to continue to find ways where we can remove the burden.

Michael Horne:
And so certainly RIP Medical Debt is an activity and really an initiative that is needed, frankly. Particularly again, going back to looking at Dallas County, looking at where our vulnerable populations are, the challenges that they are faced with, and opportunities we have to consistently remove as many barriers and burdens as possible. I think certainly from a financial standpoint, to the extent that we can offer a form of emancipation by removing the debt, that definitely puts us on a stronger pathway by which individuals ultimately can be better positioned to engage in the fullest sense in society as they desire.

George Mason:
Well, right. They'll be able to get loans now because they've got that off their books. They'll be able to walk around without the heavy weight that they're carrying, looking over their shoulder, wondering whether when the next collector's going to call and that sort of thing. From a faith standpoint, both in the Hebrew scriptures and the Christian scriptures, there is this language about the good news to the poor. That God is bringing good news to the poor, and that part of that is the year of Jubilee and the cancellation of debts and the sabbatical year and all those sorts of things that are part of a very inconvenient message to the economic systems we live in, and yet are liberation and emancipation for many people. And so how do we make that connection right in our own times, and that's what we're trying to do.

George Mason:
Michael, I wonder if as we get ready to close here, if you could say a word about how you view this as a spiritual calling of your own. We call this program Good God. The God part and the good part go together. I wonder if you could speak to that personally.

Michael Horne:
They really do. If I think about my upbringing and certainly the lessons that I learned as a child and what has sustained me in my faith in particular, there are two scriptures that certainly come to mind. The first is Isaiah 61:1, and really recalling the prophet Isaiah speaking about binding of the broken hearted, proclaiming freedom to the captives. The second is Matthew 25:35, "I was hungry, you gave me food. I was thirsty, you gave me drink. I was a stranger, you welcomed me." I think at the heart of both of those scriptures is this idea of connectedness, really the act of gaining increased proximity to those around us with a goal of realizing the kind of the wholeness that must exist that we, I believe are called to perfect.

Michael Horne:
I think if we can shorten the distance between ourselves and others we often also I think start to breed more compassion and empathy. When I think about that empathy in particular in the work that I'm called to do now, my life's work, really it's not a passive operation but it's one of agency. We're having to actively choose that we're going to dismantle the walls of division. We're going to dismantle the barriers, debt, access to care, educational opportunities, transportation, food, access, to healthy foods. We're going to take all those walls that are erected and replaced them with bridges of love, of understanding, and I would say this corporate responsibility that we have to our brothers and sisters. I definitely believe in that notion of unconditional, [inaudible 00:28:29] love, this unwavering, this relentless, that is preoccupied with this belief that my success is only tied to the success of others, therefore, I'm going to actively work every single day to ensure that collectively, we all can realize the promise of potential that we have.

Michael Horne:
Whether it's raising philanthropic support, increasing awareness of the work that Parkland is doing and why we need to make these investments, for me, it is certainly tied to those core beliefs of service, those core beliefs of making sure that we are actively reaching out to those around us and doing so with a spirit of compassion, love, and empathy.

George Mason:
Well Michael, you are a wonderful spokesperson for this work, and we are so glad that we get to do it with you in Dallas County. Thank you for your labors on behalf of Parkland and Dallas County generally, and your spiritual motivation that inspires us too. We look forward to lots more times working together in the future. God bless you from Good God.

Michael Horne:
Thank you.

George Mason:
Glad to have you.

George Mason:
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