Health Care Landscape
Building Healthier Communities One ZIP Code at a Time
Florida Blue takes on ‘unsustainable' health care costs by addressing longstanding challenges in the state's poorest communities.
Suzanne Pickett was caught by surprise at a baby shower she helped throw for Jacksonville residents in need of help last fall. The CEO of the Historic Eastside Community Development Corp. and other hosts had snacks and gift cards for about 40 new moms and mothers-to-be, and they crossed their fingers that so many would come. They were way off on the headcount.
They had 168. “There was a line literally around the building,” Pickett recalls. “I just had no idea of the challenge and the resources needed.”
It was Pickett’s first encounter in the neighborhood with the unmet needs of mothers, but it was not the last.
High rates of maternal death and infant mortality are among the avoidable — yet over the decades intractable — tragedies common in Eastside, a historic and once flourishing community within Jacksonville that now constitutes one of Florida’s poorest ZIP codes. For Pickett and her partners, the community also is the staging ground for a leading-edge effort to make health care more effective, efficient and sustainable by addressing the leading preventable cause of chronic diseases and disruptive illnesses: Generational poverty.
Jacksonville-based Florida Blue and an alliance of corporate and community entities — spanning finance, philanthropy and even the sporting world, with the Jacksonville Jaguars — are among the forces helping turn around the health of the community and set a new course for economic progress. In Eastside’s ZIP code, nearly a quarter of the households live in poverty and more than a quarter of adults did not graduate from high school, according to the U.S. Census Bureau. It is a community beset by challenges accumulated across generations: Limited access to affordable, fresh foods; substandard housing; high stress; environmental triggers for respiratory illnesses such as asthma; and low birthweight babies. “The impact on individuals is too great, in terms of quality of life, and from a cost perspective we know we have to intervene much further upstream,” says Kelli Tice, a family physician who leads the effort as Florida Blue and parent company Guide- Well’s vice president of medical affairs and chief health equity officer. “We know that only 20% of your outcomes come from the clinical experience; 80% is what’s in your environment.”
The effort to dig into the root causes of health disparities grew out of a global reality laid bare by the COVID-19 pandemic: Lower-income communities where workers held essential jobs that put them in harm’s way were especially vulnerable to COVID-19 due to underlying health conditions such as diabetes, high-blood pressure, asthma and emphysema. Many workplaces became ground zero for the impact of health disparities, both in the harm to people in those jobs and the insurance cost for employers, Tice says.
In January 2022, Tice — a Florida A&M University alum and 1998 graduate of the University of Florida’s College of Medicine who went on to serve as state medical director for the Florida Department of Health — became GuideWell’s first chief health equity officer after serving as the clinical lead for Florida Blue’s COVID- 19 response. She is part of a cadre of health care officers now in C-suite level roles working to curb preventable illnesses linked to health disparities.
Florida Blue’s Growing Resilient Communities campaign is investing $25 million in partnerships with community organizations that provide on-the-ground services in Florida’s five poorest ZIP codes. In addition to Eastside, the others are in Fort Lauderdale, Orlando and Tampa, which has two ZIP codes targeted in the effort. “Our goal is to create a system that no matter what your characteristics might be, you have the same opportunity to achieve your best level of health,” Tice says. “It’s big work.”
The Resilient Communities campaign is built on a business case that casting a wider net of solutions can curb an unsustainable upward trend described by global accounting firm Deloitte in its June report titled “U.S. Health Care Can’t Afford Health Inequities.” Deloitte actuaries concluded that health inequities account for approximately $320 billion in avoidable annual health care spending that if left unaddressed could grow to $1 trillion by 2040. “The projected rise in health care spending could cost the average American at least $3,000 annually, up from today’s cost of $1,000 per year,” Deloitte forecasts. Analyses by the Kaiser Family Foundation, W.K. Kellogg Foundation and Altarum also report that health inequities associated with poverty are bleeding human and financial capital in ways that can cripple economies.
Pat Geraghty, president and CEO of both GuideWell and Florida Blue, says the data on unequal health outcomes is clear and points to the necessity of interwoven solutions GuideWell is orchestrating in Florida. Geraghty acknowledges that efforts to reverse multi-generational poverty require decades of consistent funding to produce results, but he pledges that Guidewell and Florida Blue are in it for the long haul.
“We see this struggle playing out every day: A mother working two jobs yet still unable to afford healthy food for her kids; an elderly person missing doctors’ appointments because he lacks transportation; a college student forgoing care because she doesn’t think she can afford insurance. These aren’t anecdotes. They’re real people,” Geraghty says. “It is our responsibility and obligation to drive efforts to build a health care system that works for everyone.”
Tice says rooting out contributing factors to health problems requires knocking down barriers such as lack of access to medical care, food insecurity, substandard housing, lack of transportation and other hardships that keep some communities mired in poverty and poor health.
“Folks don’t understand the cost: The impact to families of premature preventable deaths, the impact to communities as we lose great human capital, who die prematurely because of cardiovascular risk, the loss of moms due to maternal impacts, especially Black moms who are three times more likely to die. Those things, we’re not measuring them, but they’re still impacting our communities,” Tice says.
“We don’t want to get five years or 10 years, really any further down the road talking about this off the sides of our desks,” she continues. “The health-care system can’t continue on the trajectory that it’s on.”
So what does the impact of this effort on the ground look like? In Eastside, a corner grocery store that traded in fresh food, supplies and community news for 90 years will soon reopen, selling fresh produce in the neighborhood for the first time in 12 years (“Healthy Return on Investment,” page 54). Key partners are Goodwill, VyStar Credit Union, Baptist Health, the Jacksonville Jaguars, Lift Jax and the City of Jacksonville. A birthing doula is now on site regularly at Pickett’s offices to provide maternal health care and information, while United Way is delivering essential mother/baby supplies for mothers in need.
Aging homes that have housed generations of Eastside families are being repaired, restored and made energy-efficient through the efforts of the Historic Eastside Community Development Corp., Lift Jax, Local Initiatives Support Corp. of Jacksonville, United Way and the philanthropy of former Jacksonville Jaguars co-owner Delores Barr Weaver.
Rudy F. Jamison Jr., director of the Institute for the Study of Race and Ethnic Relations and Director of the Urban Educator Scholars Program at the University of North Florida, is one of five professionals building homes in Eastside through Project Boots despite historic redlining that even now makes it difficult to finance upscale homes in the community where he grew up. “It gives people like me inroads to go back to the neighborhood that I love,” Jamison says. “Without Project Boots and Florida Blue and Lift Jax, someone like me wouldn’t have an opportunity to put up a 2,300-sq.-ft. home. The bank would literally not put up the money (for lack of comparables). I would have to pay cash.”
Project Boots homeowners receive $14,600 in incentives for taking the financial risks needed to help break the cycle of meager investments in Eastside. The cycle grew out of lending decisions driven by federal redlining maps from 1934 to 1968 that warned banks not to make “hazardous” home loans in minority neighborhoods, a practice that prevented the accumulation of generational wealth. Working “from the inside out” with homegrown partners to create a mix of resident incomes, educational attainment and professional experiences will lift aspirations of all kinds, including educational goals and healthy lifestyles, Jamison predicts.
The idea is to empower Eastsiders to thrive in place — “withintrification” rather than gentrification — to live safely and comfortably, growing in education, health and wealth, alongside newcomers and homeowners.
Travis Williams, vice president of operations and impact at Lift Jax, Florida Blue’s “community quarterback,” is all in. He and his wife grew up in Eastside, with many extended family nearby, and spent the first years of their marriage in the neighborhood. He went to prep school and college in Jacksonville, started a business with Northwestern Mutual Wealth Management and later sold it to shift into community work. Now he works in Eastside and his daughter goes to John Love Early Learning Center. “She’s going to grow up totally different than I did, than my wife did. It’s a really good school,” he says.
Pickett also grew up in Eastside, but moved away. A visual artist, she returned to the community for what she thought would be a short stay but found she did not want to leave again. Twelve years later, she is one of the resident linchpins in Eastside’s community redevelopment.
“I really did just jump in because I wanted to save the neighborhood,” Pickett says. “My family had property, but we moved away, like most people who couldn’t wait ‘to get across the bridge.’ After I went through a divorce, I moved back into our family home to do some repairs and rehab so I could rent it out. But when I really started getting into the neighborhood again, it made me curious as to why, with all the development happening around us in Jacksonville, why nothing was happening in the Eastside. So, I got involved. The residents told us, you know what we need. Just do something.”
“And,” says Pickett, “it’s finally happening.”