Border Study Shows Holistic Approach to Healthcare Improves Chronic Conditions


South Texas healthcare philanthropy built a first-of-its-kind project to fund and study integrated care for low-income, uninsured residents in underfunded border communities.


A new U.S.-Mexico border study shows that providing physical and mental healthcare together improves conditions like diabetes and depression in South Texas. The study focused on improving wellness for low-income, uninsured Hispanic residents who face multiple barriers to accessing healthcare and are also more likely to have chronic health conditions. Almost 40% of Hispanic patients with Type 2 diabetes also have depression, making it even more critical to get the right mix of physical and mental healthcare.

A five-year project called Sí Texas: Social Innovation for a Healthy South Texas, studied the effectiveness of integrating physical and mental healthcare in a single visit, which enables providers to more effectively coordinate care so that neither physical nor mental healthcare needs are neglected. This approach, called Integrated Behavioral Health (IBH), is taking hold in many areas of the country, but until this project, had never been studied in low-income, uninsured, predominantly Hispanic populations.

Sí Texas was developed by San Antonio-based Methodist Healthcare Ministries of South Texas, Inc. The healthcare non-profit has focused its services in South Texas for nearly 25 years. Communities near the border and along the coastal bend offered the ideal population and healthcare access conditions for the study, but an added challenge in that South Texas is often ignored when it comes to grant funding and philanthropy. Organizations that might provide individual grants in the region aren’t large enough to fund a project of this scope, and seven of the 12 counties in the project have no foundations that fund health initiatives.

“We know that physical, mental, and spiritual health together are the key to wellness, but for many low-income South Texas residents, realities like lack of transportation, and other social or economic factors get in the way of access to healthcare,” says Jaime Wesolowski, president and CEO of Methodist Healthcare Ministries of South Texas, Inc. “Border communities and people living in rural areas are especially impacted. We work to improve health equity in the region, and we want the partners we work with to have the resources to be community health leaders in their own right. Sí Texas was an opportunity to deliver more effective care and to support sustainable operational growth for providers and clinics in South Texas.”

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Methodist Healthcare Ministries created a partnership between a federal agency that provides funding for community initiatives, and regional and local funders––together, the resources added up to $60 million to study the effectiveness of IBH in counties where income and access to healthcare are among the lowest in the nation and conditions like diabetes and depression are among the highest.

The major funding came from the Corporation for National and Community Service (CNCS), Methodist Healthcare Ministries, and Harlingen-based Valley Baptist Legacy Foundation; several smaller, regional co-investors also contributed. Eight healthcare organizations in 12 counties were selected to implement IBH programs, study the effectiveness of the approach with patients who had diagnoses for conditions like diabetes, depression, high blood pressure, anxiety, and obesity, and evaluate the results and the impact. The clinics were a diverse group of local mental health authorities, federally qualified health clinics, primary care charity clinics, and academic institutions operating clinics in the communities targeted for the project. During the study, Sí Texas provided IBH healthcare for 51,937 low-income, uninsured patients and clients.

“Sí Texas addressed real barriers in South Texas, where working, poor residents face so many obstacles to accessing healthcare; there’s a tremendous need to find better ways to treat these common chronic conditions,” says Jennifer Knoulton, RN, Methodist Healthcare Ministries’ vice president of regional operations. “We’ve been working in South Texas communities for years and we’re familiar with the unique needs of low-income, uninsured people living in this region. Transforming the type of care people have access to can change lives over generations. This project was important to us from a care delivery standpoint, but also because we believe that the best healthcare treats the body, mind, and spirit. Sí Texas was a way for us to introduce IBH and expand whole-person health care in South Texas.”

The results confirm that IBH is effective in treating chronic health and mental health conditions in low-income, uninsured, predominantly Hispanic populations. The success of the study in South Texas has powerful implications for successful healthcare delivery outcomes in parts of the country facing similar conditions.

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