rwjf-tag: Building the business case

van Beek, E., Eckel, D., & Taylor, A. (2018, March). Investing in social services as a core strategy for healthcare organizations: Developing the business case. Washington, DC: KPMG Government Institute and The Commonwealth Fund.

This report explores the current landscape of investments targeting the social determinants of health (SDH) as well as approaches to accelerate the uptake of SDH investments into healthcare business operations through key informant interviews with healthcare payer and provider executives, an extensive literature review, and the convening of an Advisory Council and a Social Services… Read more »

The SCAN Foundation. (2019). Blueprint for health plans: Integration of community-based organizations to provide social services and supports. Long Beach, CA: The SCAN Foundation.

This report examines the challenges and opportunities that health plans serving the dual eligible population face and a roadmap for how plans can develop networks that reflect both the social and medical needs of members. Health plans are only one part of the system that serves the dual eligible population, and coordination efforts by all… Read more »

Regenstein, B.M., Trott, J., Williamson, A., & Theiss, J. (2018). Addressing social determinants of health through medical-legal partnerships. Health Affairs, 37(3), 378-385.

This article draws upon national survey data and field research to identify three models of the medical-legal partnership that health care organizations have adopted and the core elements of infrastructure that they share. The medical-legal partnership is a collaborative intervention that embeds civil legal aid professionals in health care settings to address seemingly intractable social… Read more »

Moving Healthcare Upstream. (2018). Policy Leadership for Health Care: Transformation Formalizing Our Commitment to Communities. Wilmington, DE; Author.

This paper identifies specific institutional policies and civic engagement strategies that can be used by hospitals and health systems to codify, sustain, and scale practices that address social determinants of health (SDH) in local communities. This paper synthesizes these exemplars using a framework of key principles and associated activities and policies required for system transformation… Read more »

Hostetter, M., Klein, S., & McCarthy, D. (2018, May 20). Vermont’s bold experiment in community-driven health care reform. Washington, DC: The Commonwealth Fund.

This article describes how OneCare, a large accountable care organization (ACO) in Vermont, addresses the social needs of its beneficiaries, under Vermont’s Blueprint for Health. The Blueprint for Health, a statewide initiative, compels public and private payers to support nurses, social workers, community health workers, and others working to help patients manage their chronic conditions,… Read more »

Hostetter, M., & Klein, S. (2017, June 21). Creating pathways and partnerships to address patients’ social needs. Washington, DC: The Commonwealth Fund.

This article examines how new technologies and payment models can support efforts by health care providers and plans to assess patients’ nonmedical risks and work with nonprofit agencies, social services providers, and other community partners to help address them. The article provides examples of how hospitals/health systems address nonmedical needs, how to build clinical-non-clinical partnerships,… Read more »

Heeringa, J., Lipson, D., Machta, R., Lane, K., & Vogt, R. (2018, January). Designing Medicaid Delivery System Reform Incentive Payment demonstrations to reward better performance. Baltimore, MD: Centers for Medicare and Medicaid Services.

This brief describes differences in incentive design features of six Delivery System Reform Incentive Payment (DSRIP) demonstrations and assesses their strengths and limitations in promoting provider participation in delivery system reform and value-based payment (VBP) arrangements. While the effects of DSRIP incentive designs on outcomes are not yet known, this study finds that differences in… Read more »

Ash, A., Mick, E., Ellis, R., Kiefe, C., Allison, J., & Clark, M. (2017). Social determinants of health in managed care payment formulas. JAMA Internal Medicine, 177(10), 1424-1430.

This article seeks to answer the question, can social determinants of health (SDH) be included in Medicaid payment formulas so as to pay more equitably for the care of socially vulnerable individuals? Managed care payment formulas commonly allocate more money for medically complex populations, but ignore most SDH. Outcomes examined overall were model explanatory power,… Read more »

Onie, R. (2018). Integrating social needs into health care: A twenty-year case study of adaptation and diffusion. Health Affairs. 37(2): 240-247.

The US health care system has recently begun to account for patients’ unmet social needs in care delivery and payment reform. This article presents a twenty-year qualitative case study of five stages of diffusion—testing and learning, standardization, replication, shifting from doing to enabling, and catalyzing broad adoption—of a practical approach for integrating social needs into… Read more »

Gray, E.M., & Aronovich, R. (2016, April). Producing an ROI with a PCMH: Patient-centered medical homes can deliver high-quality care and produce a healthy ROI for organizations that are willing to invest the time and effort required to plan for the transition and maintain the model. Healthcare Financial Management, 70(4), 7479.

This article examines how patient-centered medical homes (PCMH) can produce a return on investment (ROI). As organizations transition to and engage in this model of care, it is imperative that they fully consider all the financial and temporal requirements that must be addressed to successfully develop and operate a PCMH. Organizations also should explore the… Read more »

Basu, A., Kee, R., Buchana, D., & Sadowski, L.S. (2012). Comparative cost analysis of housing and case management program chronically ill homeless adults compared to usual care. Health Services Research, 47(1 Pt 2), 523-543.

The objective of this study was to assess the costs of a housing and case management program in a novel sample-homeless adults with chronic medical illnesses. The study used data from multiple sources: (1) electronic medical records for hospital, emergency room, and ambulatory medical and mental health visits; (2) institutional and regional databases for days… Read more »

Dodd, S.J., Ruffins, J. & Arzola, D. (2018). Improving health while saving money: Lessons learned from a supportive housing program for young adults with HIV. Sexual Research and Social Policy, 15(2), 163-171. Sex Res Soc Policy.15: 163.

This article presents findings of a program evaluation of the Bailey House Success Through Accessing Rental Assistance and Support (STARS) Program, a 20-unit scatter-site permanent supportive housing program for homeless or unstably housed HIV-positive young adults ages 18–24. A harm reduction and strength-based approach is utilized to connect HIV+ individuals with medical care and other… Read more »

Oftelie, A.M. (2014). The Human Services Value Curve: A Framework for Improved Human Services Outcomes, Value and Legitimacy. Cambridge, MA: Leadership for a Networked World.

To help human services leaders make progress on their capacity-building journey, Leadership for a Networked World reviewed best practices and worked with practitioners as part of the Human Services Summit at Harvard University to develop a framework referred to as the “Human Services Value Curve.” As a human services organization advances along the curve, the… Read more »

Oftelie, A.M. (2010). Report from the 2010 Human Services Summit at Harvard University: The next generation of human services: Realizing the vision. Cambridge, MA: Leadership for a Networked World.

This paper, a product of the 2010 Human Services Summit at Harvard University, aimed to help human services leaders envision a transformation journey for their own organization and realize their vision through concrete actions. To inspire and guide efforts, the paper coupled insights from the Human Services Summit at Harvard with case-based examples from human… Read more »

Nichols, L.M., & Taylor, L.A. (2018). Social determinants as public goods: A new approach to financing key investments in healthy communities. Health Affairs, 37(8), 1223-1230.

This article argues that underinvestment in social determinants of health stems from the fact that such investments are in effect public goods, and thus benefits cannot be efficiently limited to those who pay for them—which makes it more difficult to capture return on investment. Drawing on lesser-known economic models and available data, this article shows… Read more »

Tabbush, V. (2012). Overview of preparing community-based organizations for successful health care partnerships (Report). Long Beach, CA: The Scan Foundation.

To better understand specific opportunities for partnerships between community-based long-term services and healthcare systems in California, the Scan Foundation developed this series of background briefs. Health care reform generally, and more specifically the Patient Protection and Affordable Care Act (ACA), will continue to dramatically impact organizations in the health sector far into the future. Community-based… Read more »

Goolsby, L., & Levin, B. (2012). A framework for alternative human service financing. Policy & practice, 70(5).

This article describes how leaders from the American Public Human Services Association (APHSA) are examining ways to move human services away from its current unsustainable trajectory and toward viable new funding options, including blending or braiding program funds; supplementing public funds with investments from the private and philanthropic sectors; and other funding alternatives that would… Read more »

Kindig, D.A., & Isham, G. (2014). Population health improvement: A community health business model that engages partners in all sectors. Frontiers of Health Services Management, 30(4), 3-20.

In this article, the authors suggest the development of multisectoral community health business partnership models. Such collaborative efforts are needed by sectors and actors not accustomed to working together. Healthcare executives can play important leadership roles in fostering or supporting such partnerships in local and national arenas where they have influence. The authors develop the… Read more »

Meiners, M.R., Mokler, P.M., Kasunic, M.L., Hawthornthwaite, S., Foster, S., Scheer, D., & Maldonado, A.M. (2014). Insights from a pilot program to integrate medical and social services. Home Health Care Quarterly, 33(3),121-136.

This study examines lessons learned from the design, implementation, and early results of an integrated managed care pilot program linking member benefits of a Medicare-Medicaid health care plan with community services and supports. The health plan’s average monthly costs for members receiving an assessment and services declined by an economically meaningful, statistically significant amount in… Read more »

Klein, S., McCarthy, D., & Cohen, A. (2014). Health Share of Oregon: A community-oriented approach to accountable care for Medicaid beneficiaries. New York, NY: The Commonwealth Fund.

This report describes Health Share, a Coordinating Care Organization (CCO) in Oregon, which distributes capitated payments to member organization, which have agreed to bear the risk in providing services and access to a given population. Health Share earned 100% of its incentive pool, suggesting a very successful effort and can be considered as a model… Read more »

Somerville, M.H., Seeff, L., Hale, D., & O’Brien, D.J. (2015). Hospitals, collaborations, and community health improvement. Journal of Law, Medicine, and Ethics, 43(Suppl 1), 56-59.

This article makes the economic case for how hospitals can partner with other agencies (community based organizations, community development sector, public health agencies) to improve health. While there are some new reimbursement incentives for hospitals to achieve better health outcomes for specific populations, hospital administrators may wonder if these adequately address the higher costs incurred… Read more »

Chernof, B. (2015, August 20). Making the case for effective health care community-based organization partnerships. Huffington Post.

This article discusses the need for healthcare systems to focus on coordinated programs and include nonmedical and community-based service providers. The article discusses the economics of these partnerships. The author argues that it is time for all providers serving Americans with daily functional needs to break out of their individual silos and proactively connect to… Read more »

Abrams, M., Nuzum, R., Zezza, M., Ryan, J., Kiszla, J., & Guterman, S. (2015). The Affordable Care Act’s payment and delivery system reforms: A progress report at five years. New York, NY: The Commonwealth Fund.

In addition to its expansion and reform of health insurance coverage, the Affordable Care Act (ACA) contains numerous provisions intended to resolve underlying problems in how health care is delivered and paid for in the United States. These provisions focus on three broad areas: testing new delivery models and spreading successful ones, encouraging the shift… Read more »

Spencer, A., Lloyd, J., & McGinnis, T. (2015). Using Medicaid resources to pay for health-related supportive services: Early lessons. Hamilton, NJ: Center for Health Care Strategies.

Building off previous work by the Center for Health Care Strategies (CHCS), this brief examines how these states are using Medicaid funding for supportive services as part of broader delivery system and payment reform efforts. CHCS conducted interviews with state officials, community providers, and national experts to identify how these Medicaid programs are determining the… Read more »

Crawford, M., & Houston, R. (2015, February). State payment and financing models to promote health and social service integration. Hamilton, NJ: Center for Health Care Strategies, Inc.

This brief reviews potential financing mechanisms to facilitate integration, with a particular focus on Medicaid. Drawing from interviews with experts across the country, it offers models ranging from one-time seed funding for pilot projects to blended or braided financing arrangements that support comprehensive integration. This brief focuses specifically on financing and payment offering a menu… Read more »

Walker, R., & Norbeck, T. (2018, March 2). Physicians’ broader vision for The Center for Medicare and Medicaid Innovation’s future: Look upstream [Web log post].

This post discusses the urgent need to account for poverty and other health-related social needs as central to any truly effective health care system. The authors discuss the national debate on healthcare as an opportunity to support adoption of best practices and innovation among states, communities, and physicians and suggests 3 ideas for reform. These… Read more »

Steiner, T., & Tynan, W.D. (2016). Social determinants and collaborative health care: Improved outcomes, reduced costs. Deloitte.

This paper reviews some of the individual and collective impacts that physical health, behavioral health, and social determinants have on individuals and the US health system; examines how collaborative care models can help to improve outcomes and lower costs; discusses challenges to implementing integrated care; and suggests implications and opportunities for health plans and states.

Rubin, J., Taylor, J., Krapels, J., Sutherland, A., Felician, M., Liu, J., … Rohr, C. (2016). Are better health outcomes related to social expenditure? A cross-national empirical analysis of social expenditure and population health measures. Santa Monica, CA: RAND Europe.

This report presents findings from a longitudinal cross-national study on social spending, health outcomes, and wider societal factors. The study confirmed earlier findings of a positive association between higher social spending and improved health outcomes, even when this is tested in many different ways. Public social expenditure by governments seems to have a particularly strong… Read more »

Long, P., Abrams, M., Milstein, A., Anderson, G., Lewis, K., Apton, M., Dahlberg, L., & Whicher, D. (Eds.). (2017). Effective care for high-need patients: Opportunities for improving outcomes, values, and health. Washington, DC: National Academy of Medicine.

This report is a collaborative assessment on strategies for better serving high-need patients undertaken by the National Academy of Medicine (NAM), through its Leadership Consortium for a Value & Science-Driven Health System (the Leadership Consortium), in partnership with the Harvard T.H. Chan School of Public Health (HSPH), the Bipartisan Policy Center (BPC), The Commonwealth Fund,… Read more »

Jones, A., Lemak, C.H., Lulias, C., Burkard, T., McDowell, B., & Severson, K. (2017). Predictive value of screening for addressable social risk factors. Journal of Community Medicine and Public Health Care, 4, 030.

This study aimed to evaluate whether a screening assessment tool that identifies medical and social risk factors is predictive of healthcare costs in the absence of claims data and to evaluate the effectiveness of screening for social factors to target high cost beneficiaries. A retrospective study evaluating medical and pharmacy claims costs for newly-eligible Medicaid… Read more »

Chen, M.A., Unruh, M.A., Pesko, M.F., Jung, H., Miranda, Y., Cea, M., Garcel, J.M., & Casalino, L.P. (2016, April). The role of hospitals in improving non-medical determinants of community population health. New York, NY: New York State Health Foundation.

This report examines how hospitals can define the population to which they are accountable, either as the patients attributed to them by payers, and/or as the people living in the surrounding communities. They can focus on medical care and/or create initiatives that impact the non-medical determinants of health for that population. Hospital executives are the… Read more »

Lantz, P.M, Rosenbaum, S., Leighton, K., & Iovan, S. (2016) Pay for success and population health: Early results from eleven projects reveal challenges and promises. Health Affairs, 35(11): 2053-2061.

In this article, authors conducted an analysis of the first eleven PFS projects in the United States to investigate the potential of PFS as a strategy for financing and disseminating interventions aimed at improving population health and health equity. The PFS approach has significant potential for bringing private-sector resources to interventions regarding social determinants of… Read more »

Berenson, R.A., Hayes, E., & Lallemand, N. (2016, January). Health care stewardship: Oregon case study. Washington, DC: Urban Institute.

This brief is a case study of Oregon’s healthcare reform. Through a series of on-the-ground interviews, the authors examined the unique ways states have leveraged their authority to improve the quality and efficiency of health care systems. Lessons learned include: states must pursue, actively, constant improvements in the system – this is beyond their usual… Read more »

Adler, N.E., Cutler, D.M., Fielding, J.E., Galea, S., Glymour, M.M., Koh, H.K., & Satcher, D. (2016). Addressing social determinants of health and health disparities (Discussion paper: Vital directions for health and health care series). Washington, DC: National Academy of Medicine.

This paper discusses how addressing the social determinants of health can decrease health disparities. The authors utilize a health policy framework to address social determinants of health in order to better population health, reduce health disparities, and lower costs. The authors discuss key issues, cost implications, and barriers to progress, and examine health care financing… Read more »

Alley, D.E., Asomugha, C.N., Conway, P.H., & Sanghavi, D.M. (2016). Accountable health communities: Addressing social needs through Medicare and Medicaid. New England Journal of Medicine, 374(1), 8-11.

This perspective article examines the Accountable Health Community (AHC) model, in which the Centers for Medicare and Medicaid Services (CMS) invested a 5-year, $157 million test program. The foundation of this model is universal, comprehensive screening for health-related social needs in all Medicare and Medicaid beneficiaries who obtain health care at participating clinical sites. The… Read more »

Gottlieb, L.M., Quinones-Rivera, A. Manchanda, R., Wing, H., & Ackerman, S. (2017). States’ influence on Medicaid investments to address patients’ social needs. American Journal of Preventive Medicine, 52(1), 31-37.

Despite widespread interest in addressing social determinants of health (SDOH) as a means to improve health and to reduce health care spending, little information is available about how to develop, sustain, and scale nonmedical interventions in diverse payer environments, including Medicaid Managed Care. This study aimed to explore how Medicaid Managed Care Organization (MMCO) leaders… Read more »

Butler, S.M., Matthew, D.B, & Cabello, M. (2017, February 15). Re-balancing medical and social spending to promote health: Increasing state flexibility to improve health through housing [Web log post].

This analysis is part of The Leonard D. Schaeffer Initiative for Innovation in Health Policy, which is a partnership between the Center for Health Policy at Brookings and the USC Schaeffer Center for Health Policy & Economics. The Initiative aims to inform the national health care debate with rigorous, evidence-based analysis leading to practical recommendations… Read more »

Lee., J., & Korba, C. (2017). Social determinants of health: How are hospitals and health systems investing in and addressing social needs? Deloitte Center for Health Solutions.

The Deloitte Center for Health Solutions conducted a nationally representative online survey of about 300 hospitals and health systems to identify their current health-related social needs and activities and investments and their potential future efforts. To better understand how hospitals and health systems may be operating in the larger health care ecosystem and the challenges… Read more »