ProMedica Focuses on Community Development to Strengthen Health in Toledo, Ohio

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ProMedica Focuses on Community Development to Strengthen Health in Toledo, Ohio

ProMedica is a regional health system that serves 28 counties in southeast Michigan and northwest Ohio with 13 hospitals and 4 ambulatory surgery centers. Within this broad service area, ProMedica has worked for more than a decade to address the social, economic, and environmental factors that contribute to poor health for individuals and communities. In 2016 alone, ProMedica contributed more than $180 million in community benefits. The health system’s focus on the social determinants of health has led to a comprehensive strategy to enhance the physical and social effects of distressed housing and neighborhoods. In Toledo, Ohio, where it is headquartered, ProMedica is helping to stabilize the aging affordable housing stock, revitalize the predominantly low-income neighborhood of UpTown, and strengthen the city’s economic health through physically improving the city’s downtown.

Stabilizing Toledo’s Housing

Stable housing is a key component of ProMedica’s approach to addressing the social determinants of health. In Toledo, more than 5,000 housing units are publicly subsidized or rent restricted, but a growing number of these units are at risk of exiting affordable programs. More than half of the 747 single-family rental units funded by low-income housing tax credits have reached the end of their 15-year compliance period under the tax credit program or will reach it by 2020, significantly challenging the stability of the city’s affordable housing stock and residents’ health. In 2017, ProMedica partnered with KeyBank to provide $2.65 million to support the Year 16 Initiative, a public-private partnership to preserve the affordability of city housing that is funded through low-income housing tax credits and encourage homeownership for low- and moderate-income renters.

The partners’ funding, coordinated by the Toledo office of the Local Initiatives Support Corporation (LISC Toledo), will be used to make $7,500 forgivable loans to renters who need assistance with renovations or want to purchase their homes. ProMedica’s contribution will also be used to acquire and rehabilitate 250 homes, most of them vacant, to stabilize neighborhoods in central Toledo. According to Kate Sommerfeld, ProMedica’s president of social determinants of health, the connection between stable housing and health is critical not only for ProMedica’s patients but also for the entire community. ProMedica is especially interested in supporting the housing needs of its 17,000 employees and anticipates that by summer 2018 the company will provide downpayment assistance for entry- and mid-level employees who want to become first-time homeowners.

Revitalizing the UpTown Neighborhood

ProMedica’s involvement in the Year 16 Initiative evolved from the health system’s efforts to revitalize a Toledo neighborhood. ProMedica originally targeted UpTown for concentrated investment because hunger and limited access to healthy foods led to poor health outcomes for neighborhood residents, according to ProMedica’s 2009 community health needs assessment. In addition to screening for hunger in its patient-intake process and issuing referrals to food pharmacies, ProMedica decided to explore creating a full-service grocery store featuring healthy food. In 2015, with $1.5 million from local philanthropist Russell Ebeid, ProMedica opened the Ebeid Institute for Population Health in an abandoned four-story building in the heart of the UpTown neighborhood, one mile from Toledo’s downtown. ProMedica acquired the building from the city and used $1.5 million from the U.S. Environmental Protection Agency to remediate environmental pollution, remove underground storage tanks, and renovate the building.

ProMedica decided to remedy UpTown’s status as a food desert by reserving 6,500 square feet on the first floor of the Ebeid Institute building for a full-service grocery store. When no local or national grocer expressed interest in the location, ProMedica opened the store itself, which it continues to operate. The store, which offers fresh produce, meat, dairy products, and other healthy foods, has served 50,000 customers as of May 2018, and ProMedica expects it to break even before the end of the year.

In addition to the first-floor grocery, the Ebeid Institute building includes a second-floor teaching kitchen for classes in nutrition and healthy living. The second floor also features a computer lab and a Financial Opportunity Center (FOC), reflecting ProMedica’s multipronged approach to addressing the social determinants of health. Based on a LISC model first developed by the Annie E. Casey Foundation, ProMedica’s FOC provides services through individual consultations and group classes. These services include financial and employment coaching and counseling about income support programs such as the Supplemental Nutrition Assistance Program. According to Valerie Moffitt, program officer for LISC Toledo, FOC’s integrated service delivery strengthens the economic mobility of individuals using these services. Since the center opened, approximately 1,000 FOC participants have seen a 25 percent increase in their net income and a 17 percent increase in their credit scores.

The Ebeid Neighborhood Promise program, launched in fall 2017, is an effort to extend the Ebeid Institute’s employment and financial services to more Toledo residents. ProMedica entered a 10-year partnership with LISC Toledo to issue $20 million in grants for community programs and services. ProMedica and LISC Toledo have been gathering input and guidance to ensure that planned programs reflect resident priorities and develop the leadership capacity of residents. In addition, ProMedica and LISC Toledo contributed $25 million to a loan pool that can be used to develop affordable housing, commercial development with a focus on minority- and women-owned businesses, and other capital projects. This investment will be used in UpTown and across ProMedica’s entire service area. ProMedica intends to replicate the Ebeid Neighborhood Promise program’s place-based model in another neighborhood after implementation in UpTown.

Investing in Downtown

As part of a strategy to enhance the region’s economic health, ProMedica has contributed to several projects in downtown Toledo. In 2017, ProMedica converted a historic steam plant along the Toledo riverfront into a new headquarters. Since the completion of the $40 million project, which involved relocating 1,000 employees, other developers and businesses have invested $500 million in the downtown area. ProMedica has also revitalized Promenade Park along the riverfront, adjacent to the headquarters. To further activate the riverfront and improve the city’s downtown, ProMedica convened a group of civic and business leaders, the 22nd Century Committee, to create a master plan for downtown revitalization.

Data-Driven Approach

ProMedica is assessing its strategies to address the social determinants of health in Toledo and throughout its service area. The assessment uses the Anchor Dashboard, a collection of data in key categories that ProMedica developed in collaboration with the Democracy Collaborative. With measures in 10 categories, the dashboard will help ProMedica better understand implications for health from its nonclinical investments.

ProMedica intends to track indicators such as jobs created in UpTown, readmission rates for participants in ProMedica’s nonclinical programs, and the financial security of FOC participants. According to Sommerfeld, ProMedica will continue to work on linking its various data systems to more accurately understand the effects of stable housing and neighborhoods on individual and community health. ProMedica and its partners hope to study the relationship between health outcomes and the community investments that the health system has made in recent years.

For more information on HUD’s interest in full-service grocery stores and other ways to improve access to healthy foods in low-income neighborhoods, see “Housing and Food Insecurity.”