The voices of Urban Institute's researchers and staff
October 10, 2017

Flipping the research fellowship: Direct engagement improves practices and builds knowledge

October 10, 2017

Manmeet Kaur, executive director and founder of the Harlem-based community health organization City Health Works, is the inaugural recipient of the Janice Nittoli Practitioner Fellowship. Funded by the Rockefeller Foundation, the Nittoli Fellowship is awarded to innovative, entrepreneurial practitioners working in communities to address inequalities and is open to applications.

Kaur is currently completing her fellowship, and in the following conversation, she and Urban Institute senior fellow Elaine Waxman describe how the Nittoli Fellowship has supported the mission of City Health Works while shedding new light on effective practices that improve social determinants of health with industry-wide implications.

How has the Nittoli Fellowship enabled you to heighten the impact of City Health Works?

Kaur: The Nittoli Fellowship has been an excellent opportunity to grow, and it’s been very timely, given that City Health Works is currently transitioning from an early proof of concept to a financially sustainable and scalable organization.

The fellowship began with deep-dive conversations with Urban Institute experts in social determinants of health, labor economics, and health policy, which allowed me to both reflect on my work and share it, without being on a timetable. Based on these conversations, we built a work plan focused on helping both City Health Works and the Urban Institute understand how City Health Works has become an effective intermediary between doctors and patients.

Waxman: Fellowships are often designed so that someone doing innovative work is brought into a research organization for an on-site residency. We realized that’s not a very effective model for someone like Manmeet, who’s managing a fledgling organization, or for Urban Institute, which needs to know more about what’s happening in the field.

Instead, the Nittoli Fellowship allows Urban researchers to also travel to the fellow’s site and interact with his or her whole team. That way, the Urban team can learn more about what the problems and opportunities are and how we can contribute.

As researchers, we don’t often get the opportunity to acquire firsthand knowledge, which makes us better researchers and ask better questions. This way, we can see what processes are actually being delivered so we understand what data are most useful and how to think about their context.

What have you accomplished through the Nittoli Fellowship?

Kaur: City Health Works has yielded dramatic savings for both health providers and patients. But this is a new concept: paying for a service, not a device or a drug. And on top of that, it’s a service delivered by nonclinicians—health coaches recruited and trained in the community.

It’s hard to explain these savings from data alone. We have a wealth of examples, but we haven’t done a good job of telling these stories. That’s partly why Urban and I agreed to start a qualitative study to help City Health Works understand what exactly we are doing to arrive at these outcomes.

Urban’s engagement with City Health Works also has led us to put together a policy brief on medication. The research community is already aware of the complexity that leads patients to not comply with medications, but there’s not much focus on how patients’ self-management skills are a critical part of proper medication use. The new policy brief will provide practical advice to practitioners and could help improve the entire industry.

Waxman: To initiate our qualitative study, a team of Urban researchers met with City Health Works’ management team, as well as health coaches employed by City Health Works and physicians who have referred patients for help managing their diabetes and other chronic diseases. Directly engaging with these people not only gave us firsthand knowledge, but made better use of Manmeet’s time, because she didn’t have to be our only point person.

By engaging with City Health Works, we realized that the organization was sitting on incredibly valuable data. Their data tells a story about what’s happening with low-income people in their community and across the country. It’s something that we can help analyze and share with providers and the field at large to help build understanding about the barriers people face when managing chronic disease.

Through our collaborative qualitative research project and policy brief on medication, we’re aiming to not only improve the City Health Works services, but the entire field. City Health Works has the opportunity to learn more about how to build research into their ongoing practices by working alongside us on these projects.

What have you gained through the Nittoli Fellowship that you didn’t expect?

Kaur: I’ve enjoyed the surprise opportunity to add City Health Works’ voice to a national conversation about the future of work. We’ve showed the promise of employing people who are not clinicians and proven that they can have incredible impact on savings and improving health outcomes.

A lot of our outcomes are consistently above industry standards, which is particularly special given that we are a lay workforce. I’ve loved talking to Urban’s labor economist Pam Loprest and seeing her team’s observations about City Health Works’ model.

In the future, I would love to continue building upon the work we’ve accomplished in a less intensive way. I look forward to ongoing engagement with Urban Institute to help spread the word about what we are doing and to continue applying the lessons we’ve learned.

Waxman: The inaugural year of the Nittoli Fellowship proved to me that sending the Urban Institute into a fellow’s work environment, rather than solely vice versa, is an incredibly effective way to improve practices while building knowledge on an important subject. I’m excited to do it again next year.

Elaine Waxman (third from right) and a team of Urban researchers visited Manmeet Kaur (center) and her organization City Health Works in Harlem. Photo by Jillian West for the Urban Institute.


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