rwjf-tag: Data tracking and sharing

Romero, D., Echeverria, S.E., Du, M., Roberts, L., & Pozen, A. (2018). Development of a wellness trust to imprve population health: Case-study of a United States urban center. Preventive Medicine Reports, 2018(10), 292-298.

This study aimed to understand the necessary tenets for a wellness trust in Brooklyn, New York and examined community interest and political will; administrative, financing, and leadership structures; and metrics and data sources to monitor and assess impact. Wellness trusts, modeled after financial trusts support primary health prevention in community settings, provide an innovative opportunity… Read more »

Berkowitz, S.A., Brown, P., Brotman, D.J., Deutschendorf, A., Dunbarb, L., Everetta, A., … On behalf of the J-CHIP Program. (2016). Healthcare case study: Johns Hopkins Community Health Partnership: A model for transformation. Healthcare, 2016(4), 264-270.

This article describes the Johns Hopkins Community Health Partnership (J-CHiP), a partnership between Johns Hopkins Medicine (JHM) and two grassroots community-based organizations (CBO). J-CHiP is a novel care coordination program that provides services in homes, community clinics, acute care hospitals, emergency departments, and skilled nursing facilities. J-CHiP was formed as a regional approach to transformation… Read more »

Amarasingham, R., Xie, B., Karam, A., Nguyen, N., & Kapoor, B. (2018, January 5). Using community partnerships to integrate health and social services for high-need, high-cost patients. Washington, DC: The Commonwealth Fund.

This brief profiles and classifies burgeoning community-level efforts to integrate the activities of disparate social service organizations with local health care delivery systems in order to identify common challenges and solutions to address the challenges. A mixed-methods approach, including literature search, surveys, and semi-structured interviews with program leaders, and consultation with expert panels was used…. Read more »

Dorn, S. (2011). How human services programs and their clients can benefit from national health reform legislation. Washington, DC: Urban Institute.

To help human services advocates and administrators understand and take advantage of these opportunities while limiting the risks presented by health reform, this paper begins by describing the ACA’s key provisions. It then analyzes how other need-based programs could build on the ACA to implement 21st-century eligibility approaches with highly streamlined methods of enrollment and… Read more »

Mattessich, P.W., & Rausch, E. J. (2014). Cross-sector collaboration to improve community health: A view of the current landscape. Health Affairs, 33(11), 1968-1974.

This article offers an empirical perspective on the general status of such collaboration based on results from a national survey of practitioners in the community development and health fields. Study results show that cross-sector efforts to improve health are widespread across the United States. Community development organizations, including community development financial institutions, support a wide… Read more »

McGinnis, T., Crawford, M., & Somers, S. (2014, July). State policy framework for integrating health and social services. New York, NY: The Commonwealth Fund.

This issue brief describes three essential components for integrating health, including physical and behavioral health services and public health, and social services: 1) a coordinating mechanism; 2) quality measurement and data-sharing tools; and 3) aligned financing and payment. It also presents a five-step policy framework to help states move beyond isolated pilot efforts and establish… Read more »

Prevention Institute. (2013, February). Opportunities for advancing community prevention in the State Innovation Models initiative [Memo]. Oakland, CA: Author.

This memo argues that State Innovation Models (SIM) represent an opportunity for states to refocus their healthcare systems in ways that reduce costs and improve outcomes, with a focus on prevention at the population level. To do so, the following are needed: data collection tools; expanded workforce capacity, including the training and incorporation of “navigators”… Read more »

Galloway, I. (2014). Using pay-for-success to increase investment in the nonmedical determinants of health. Health Affairs, 33(11), 1897-1904.

This article discusses how fee for service models encourage treating illness and discourage spending to address social determinants of health. Social Impact Bonds and similar mechanisms can help bring dollars into the sector while ensuring that public reimbursements only go to successful programs. However, public agency data sharing is needed to support these efforts.

Butler, S., Grabinsky, J., & Masi, D. (2015). Hospitals as hubs to create healthy communities: Lessons from Washington Adventist Hospital. Washington, DC: Brookings Institute.

This paper explores the potential of hospitals to be such hubs by examining the experience of Washington Adventist Hospital (WAH), a community hospital in Maryland. The WAH experience highlights several challenges facing hospitals seeking to be community hubs. In this paper, the authors first describe Maryland’s unique health care financing system, which has helped encourage… Read more »

Guyer, J., Shine, N., Ruowitz, R., & Gates, A. (2015). Key themes from delivery system reform incentive payment (DSRIP) waivers in 4 states. Menlo Park, CA: Kaiser Commission on Medicaid and the Uninsured.

This report provides an early look at the impact of Delivery System Reform Incentive Payment (DSRIP) waivers on Medicaid payment and delivery systems. The relies on interviews with stakeholders to identify emerging trends and themes. It is based on interviews conducted with state officials, providers and advocates in three states that have adopted the Medicaid… Read more »

Sparer, M., & Muenning, P. (2016, May). (Re)defining the healthcare delivery system: The role of social services. KPMG Government Institute & the Mailman School of Public Health at Columbia University.

In May 2015, the Mailman School of Public Health, through its Department of Health Policy and Management (HPM), and KPMG LLP (KPMG) jointly hosted a conference to consider key questions raised by New York’s Delivery System Reform Incentive Payment (DSRIP) and similar initiatives that seek to bridge the gap between social services and health. The… Read more »

Association for Community Affiliated Plans. (2016, April). Integrating physical and behavioral health care: An initiative planning toolkit for health plans. Author.

This toolkit was developed by the Association for Community Affiliated Plans (ACAP). ACAP convened a collaborative of ACAP-member health plans to focus on improving integration of behavioral and physical health services. This toolkit reflects project planning process, lists the resources provided to collaborative plans, and summarizes a subset of ACAP-member health plan projects, whether already… 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 »

Hester, J.A., Stange, P.V., Seeff, L.C., Davis, J.B., & Craft, C.A. (2015). Toward sustainable improvements in population health: Overview of community integration structures and emerging innovations in financing (CDC Health Policy Series No.2). Atlanta, GA: Centers for Disease Control and Prevention.

This report describes that how, after Accountable Care Organizations, the next evolution is to focus on community and population health to lower the incidence of disease overall and improve quality of life for may individuals at once. This requires data that can see outside the clinical setting to capture outcomes for a total geographically defined… Read more »

National Quality Forum. (2017, December). A framework for Medicaid programs to address social determinants of health: Food insecurity and housing instability. Washington, DC: Author.

This report describes a framework for state Medicaid programs to support the collection of social determinants of health data and the integration of health and nonhealth services, using food insecurity and housing instability as illustrative examples. In collaboration with the Centers for Medicare & Medicaid Services (CMS), the National Quality Forum (NQF) convened an Expert… Read more »

Oftelie, A.M. (2017). Report from the 2017 Human Services Summit at Harvard University: The next generation of human services: Realizing the vision. Cambridge, MA: Leadership for a Networked World.

This summary synthesizes findings from the 2017 Health and Human Services Summit: Creating the Future of Outcomes and Impact. The summit provided an unparalleled opportunity to learn from and network with the world’s foremost human services practitioners, Harvard faculty and researchers, and select industry experts. In particular, this report contains special sections on 1) an… Read more »

Bachrach, D., Bernstein, W., Augenstein, J., Lipso, M., & Ellis, R. (2016, April). Implementing New York’s DSRIP program: Implications for Medicaid payment and delivery system reform. New York, NY: The Commonwealth Fund.

This report examines New York’s experience implementing its DSRIP waiver to identify emerging issues enabling or impeding Medicaid transformation. Findings are informed by two rounds of interviews: the first with federal and state officials and thought leaders from national health care organizations, and the second with New York stakeholders involved in on-the-ground implementation efforts, including… Read more »

Partnership for Healthy Outcomes. (2017, October). Bridging community-based human services and health care case study series. Hamilton, NJ: Author.

This report provides case studies on partnerships between community-based human services and health care. The case studies illustrate the potential for diverse and effective models between CBOs and health care organizations. They provide important lessons for how successful partnerships deliver services, share information, secure funding, engage their communities, and evaluate success. The following traits of… Read more »

Accenture. (2017). Albany Medical Center PPS leads regional initiative to boost care quality and slow Medicaid costs. Author.

This is a case study of a Provider Performing System (PPS) in New York State. New York is one of the first states to participate in the Delivery System Reform Incentive Payment (DSRIP) initiative, a new federal program that aims to improve healthcare quality for Medicaid patients. The PPS, Albany Medical Center, called on Accenture… Read more »

Gottlieb, L. Ackerman, S., Wing, H., & Manchanda, R. (2017). Understanding Medicaid managed care investments in members’ social determinants of health. Population Health Management, 20(4), 302-308.

This article examines Medicaid managed care investments in social determinants of health. Though interest in social determinants of health is widespread, but information about how to develop, sustain, and expand such efforts is scarce. While Managed Care Organizations are trying to make investments, several challenges exist including clinical integration, financing, sustainable funding, and regulatory constructs.

Amarasingham, R., Xie, B., & Karam, A. (2018, January). Using community partnerships to integrate health and social services for high-need, high-cost patients. Washington, DC: The Commonwealth Fund.

This brief profiles and classifies community partnership initiatives to understand common challenges and identifies solutions. The authors identified five common challenges: inadequate strategies to sustain cost-savings, improvement, and funding; lack of accurate and timely measurement of return on investment; lack of mechanisms to share potential savings between health care and social services providers; lack of… Read more »

Beers, A., Spencer, A., Moses, K., & Hamblin A. (2018). Promoting better health beyond healthcare: State-level multi-sector actions for addressing the social, economic, and environmental factors that impact health. Hamilton, NJ: Center for Health Care Strategies.

This report explores the many ways that states are collaborating across agencies to improve population health while accomplishing reciprocal goals in areas like transportation and education. It provides important lessons on how cross-sector partnerships can successfully advance health outcomes through empowering local communities, facilitating cross-sector learning and collaboration, supporting data-sharing, and cultivating cross-sector leadership. A… Read more »

Humana. (2018). 2018 bold goals progress report: Health happens where you are #morehealthydays.

This reports describes Humana’s Bold Goal, a comprehensive business and health strategy dedicated to improving the health of the communities Humana serves by 20% by 2020. Humana is prioritizing conditions and social determinants of health, both inside and outside of the clinical setting and tracking their progress using the CDC population health tool, Healthy Days…. Read more »

Hester, J. (2018). A balanced portfolio model for improving health: Concept and Vermont’s experience. Health Affairs, 37(4), 570-578.

This article first summarizes Vermont’s experience as a laboratory for health reform. It then presents a conceptual model for a community-based population health strategy, using a balanced portfolio and diversified funding approaches. The article then reviews Vermont’s population health initiative, including an example of a balanced portfolio and lessons learned from the state’s experience. This… Read more »