BY JOHN KEZER AND JESSICA PEKALA
This article explains the use of medical-legal partnerships to improve the treatment of health care patients.
As the U.S. health care system battles excessive costs, overutilization, and disjointed care—all while producing inferior health outcomes compared to other high-income countries1— policy experts and health care professionals are looking toward new, alternative ideas to fix these issues and provide higher quality, cost-effective services.2 One innovative and expanding strategy to achieve these purposes is die formation and implementation of medical-legal partnerships (MLPs). MLPs are flexible partnerships between attorneys and health care providers who work collaboratively to address patients' unmet legal needs with the overall goal of also improving the patient's health.3 While MLPs began in the early 1990s, they have been slow to take off in many areas of the country, including Colorado. This article provides an introduction to MLPs, including what role they serve, how they originated, and what MLPs exist in Colorado today.
What are MLPs?
MLPs address patients' legal concerns in conjunction with their medical care.4 The idea behind the partnership is that by addressing patients' legal needs, their overall health status will improve as well.5 Further, the "[m]edical-legal partnership teams often detect patterns in patients' needs that reveal opportunities to advance policy solutions for whole communities."
MLPs often place a legal team of attorneys, paralegals, and law students directly within a medical setting. This enables the legal team to collaborate in real time with the primary care medical providers, behavioral health professionals, and social workers who are caring for the patients. Understanding the entire picture of a patient's life, including the social determinants of health, allows the attorneys and the medical professionals to treat the patient more effectively through coordinated efforts.
Social Determinants of Health
A patient's physical well-being is one small piece of his or her overall health status. Other factors, including lack of affordable and safe housing, food insecurity, health insurance and public benefit denials, low level of educational achievement, disabilities, and legal status, can contribute negatively to one's physical and mental health.7 These factors are known as the social determinants of health. If not taken into consideration during medical treatment, they will often render that treatment useless and allow physical and mental health conditions to worsen.
For example, a patient newly diagnosed with diabetes and struggling to cover the cost of several prescriptions may find himself unable to afford food costs—especially the higher cost of healthier food. At each follow-up visit, the patient's medical provider will likely continue to counsel him on the importance of a well-balanced, healthy diet and weight loss in the overall management of diabetes. If the provider has no idea that the patient is struggling to cover the costs of food, the nutrition counseling is futile. This is where an assessment of the patient's social determinants of health, which usually involves a brief survey with a social worker or care manager, can make the difference. Identifying the need for prescription cost saving assistance or Supplemental Nutrition Assistance Program (SNAP) benefits would help this patient afford healthier food and work toward positive management of his diabetes. In collaboration with the medical provider, social worker, and care manager, an attorney with an on-site MLP could assist with the initial SNAP application and any potential appeals down the road.
The National Scene
The National Center for Medical-Legal Partnership (the National Center) was founded in 2006 and is a treasure trove of information and resources about MLPs. As stated on its website, the National Center "leads education, research, and technical assistance efforts to help every health organization in the United States leverage legal services as a standard part of the way they respond to social needs."8According to the National Center:
Last year, medical-legal partnerships helped more than 75,000 patients resolve legal issues that were impeding their health, trained more than 11,000 health care providers to...