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Addressing Social Determinants of Health through a Medical-Legal Partnership — [PODCAST] EP 88

July 26, 2022

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While patients with cancer face many physical and psychological challenges associated with their disease and/or treatment, their social, emotional, and legal needs can lead to ongoing health disparities and reduced quality of life if left unaddressed.

Hear how a unique medical-legal partnership at Virginia Commonwealth University (VCU) Health System expands the clinical team to include lawyers who address the legal issues that affect patients’ health and well-being. Learn how this 2022 ACCC Innovator Award winner redefined “comprehensive care” for patients and enabled the program’s team lead to embrace her passion to consistently find joy in her day-to-day role.


Alison Held

Allison L. Held, JD
Associate General Counsel & Director, Medical-Legal Partnership at VCU Health System
Virginia Commonwealth University Health System, VCU Massey Cancer Center

“I’m inspired every day by the work of our physicians and our nurses and all our healthcare team members [who] constantly go above and beyond…. Our director, Dr. [Robert] Winn, is very committed to addressing health disparities in our community, and [the] medical-legal partnership is just one piece of that.”



This podcast is part of a special series on the 2022 ACCC Innovator Award winners. For a deeper dive into this content, visit ACCC’s Innovator Award website.


CANCER BUZZ: Welcome back to CANCER BUZZ. The podcast of the Association of Community Cancer Centers. I'm your host summer Johnson. On today's mini episode, an award-winning program that uses a medical legal partnership to address social determinants of health that have a remedy in civil law. Since 2011, the ACCC Innovator Awards have recognized the many creative and cost-effective solutions that ACCC member programs have implemented to deliver high quality patient centered care in communities across the country.

This show is the first in a series highlighting the 2022 ACCC Innovator Award winning programs. Today we're talking to Virginia Commonwealth University Health System, VCU Massey Cancer Center, in Richmond, Virginia. Allison Held is the associate general counsel and director of VCU Medical-Legal Partnership, or MLP.

Allison Held: So, I was serving on a non-profit board of CancerLINC, which stands for Legal Information Network for Cancer. And it was during this time that the nonprofit was providing free legal services to cancer patients in our community. And I read an article in the New York Times about medical legal partnerships, and I just thought the idea was brilliant because basically what medical legal partnerships are doing is putting these legal services… partnering with legal service organizations and offering those legal services onsite in the hospital to low-income patients who have legal needs that affect their health and well-being.

So, at the time that I was serving on CancerLINC's Board, I approached another board member who was a high-level executive at Massey Cancer Center. And she and I talked about moving this organization into the hospital and forming a partnership so that we could eliminate those burdens for cancer patients, not having to pick up the phone and call when there are so many other things going on with a cancer diagnosis and treatment plan. And so, we started the medical legal partnership at Massey Cancer Center as an all-volunteer organization. And it just grew from there.

CANCER BUZZ: And what does the organization look like now?

Allison Held: We continue to have a partnership with CancerLINC, who is actually our legal partner at Massey. And CancerLINC has a staff attorney that is dedicated to our program 24 hours a week. He works onsite in the cancer center. We have a brand-new adult outpatient pavilion, and we have office space that is right on the main floor across from the registration area. So, he is available to meet with patients, providers, nurses, and social workers, about issues that are coming up with patients, legal issues that are rooted in kind of social problems for us to address.

And we also have partnerships and programs that apply across the hospital. So not just for cancer patients, we serve eight different patient populations. We have a number of lawyers that serve those populations, but CancerLINC is our primary partner at Massey for those patients.

CANCER BUZZ: How are you educating the cancer care team to connect their patients with this service?

Allison Held: We do regular presentations with our providers to refresh their memory on, you know, the kinds of services that we can provide to patients. And I will say that providing legal services as part of a hospital system is not a core mission for our hospital. And especially when we were doing this more than 10 years ago, you know, social determinants of health, weren't universally recognized at that point. So convincing doctors that it was okay to have lawyers who were roaming the halls. It was a little bit of a challenge, but as soon as we were able to improve outcomes for patients, and we were able to demonstrate the value of the work that we did, our physicians, our social workers, our case managers… quickly became our partners in this.

And so, we do regular education for our providers. We also do substantive primers. For example, we have one coming up on Medicaid eligibility, particularly for families who have mixed immigration status. We also educate on estate planning and talking about kind of the differences between wills, advanced medical directives, powers of attorney… and the way that we operate as a referral source. We are part of a clinical workflow at Massey. So, we have a web form that if you were an employee of VCU, it's on the intranet and you go to the web form, you refer a patient to us in much the same way you would refer a patient to any sub-specialty.

And we have a case that's automatically created in our system in real time. And then we follow up with that patient directly. And so, we are partnering with our providers. We often offer also curbside. We call them curbside consults. So, providers will stop by. They might be having an issue with one patient or sometimes multiple patients getting medicine or something like that. And we can often address those issues with the provider without having to even provide that direct service to a patient.

CANCER BUZZ: Can you give us an example of the work that you've been doing?

Allison Held: In Richmond, unfortunately, and this may be happening across the country too, with pandemic, you know, rental relief going away. We have a lot of evictions in the Richmond area. We're seeing an uptick in those, and we've had cancer patients who are being evicted or who are living in conditions that aren't conducive to good health. And we had a patient recently who also has a child with complex medical needs, who did not have AC. The AC was not working in her apartment for a long time. The landlord was refusing to fix it and so, we were able to get her a window unit in the interim while we work with the landlord and get the landlord to comply with the law. But CancerLINC is currently working with that family to get the AC unit installed and fixed in that unit.

CANCER BUZZ: Do you think this type of work adds to your own personal job satisfaction?

Allison Held: I have to say I am inspired every day by the work of our physicians and our nurses and all of our healthcare team members that just constantly go above and beyond and working with patients on any number of issues that affect their health and their quality of life. And working for VCU and for Massey, you know, it's a premier community focused cancer center. And our director, Dr. Winn is very committed to addressing health disparities in our community and medical legal partnership is just one piece of that.

You know, it’s one kind of tool in the toolbox to provide comprehensive, you know, fully integrated care. And I love that mission and I love the work that we do. I find it deeply meaningful, and I consider myself very lucky to be able to do this for a living.

CANCER BUZZ: You can learn more about the MLP at the upcoming ACCC 39th National Oncology Conference, October 12th through the 14th, in West Palm Beach. There's more information and a link to register in the show notes. Next week, an innovative program where primary care providers are embedded into the cancer service line. Until next time for the CANCER BUZZ team, this is Summer Johnson.

The views and opinions expressed herein are those of the author(s)/faculty member(s) and do not reflect the official policy or position of their employer(s) or the Association of Community Cancer Centers.