rwjf-tag: Publicly Available

Young, G.J. (2017, February). Hospitals in the post-ACA era: Impacts and responses. New York, NY: Milbank Memorial Fund.

This brief looks at the ways the Affordable Care Act sought to change hospitals, how hospitals are responding to these pressures, and resulting considerations for state policymakers. Of particular interest are increased hospital-provider consolidation activity, hospital participation in value-based care arrangements, and expectations for hospitals to play an increasing role in improving community health. This… Read more »

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 »

The Commonwealth Fund. No date. HNHC Payments for Social Services Calculator (BETA) [Web site].

This calculator is designed to assist community-based organizations and their medical partners in creating mutually advantageous financial arrangements for funding the delivery of social services to high-need, high-cost (HNHC) populations. These populations, which account for a disproportionately large share of health care expenditures, often have clinically complex conditions, cognitive or physical limitations, and/or behavioral health… Read more »

Soper, M. (2017, January). Providing value-added services for Medicare-Medicaid enrollees: Considerations for integrated health plans. Hamilton, NJ: Center for Health Care Strategies, Inc.

This brief explores how health plans participating in PRIDE (Promoting Integrated Care for Dual Eligibles), a project made possible by The Commonwealth Fund, are addressing members’ service needs beyond the scope of traditionally covered Medicare and Medicaid services to improve health outcomes and address social determinants of health. The brief also discusses several policy considerations… Read more »

Solomon, L.S., & Kanter, M.H. (2018). Health care steps up to social determinants of health: Current context. Permanente Journal, 2018(22), 18-139.

This article provides an overview of what the role for the United States’ health care system is in addressing the social determinants of health, how to create the right policy context for innovation, and how healthcare can partner more effectively with providers of social services to meet patients’ most pressing needs given the fragmented, typically… Read more »

Sharfstein, J.M., Gerovich, S., Moriarty, E., & Chin, D.C. (2017, August 16). An emerging approach to payment reform: All-payer global budgets for large safety-net hospital systems. Washington, DC: The Commonwealth Fund.

This article assesses the feasibility and likely outcomes of implementing global all-payer budgets in hospital systems in the United States, particularly in large safety-net hospital systems. The article reviews this concept based on the experiences of global hospital budgeting programs implemented in Maryland and planned for Pennsylvania. The article concludes that to be successful, all-payer… Read more »

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 »

Robert Wood Johnson Foundation. (2019, February). Medicaid’s role in addressing social determinants of health (Briefing series: Key Medicaid issues for new state policymakers). Princeton, NJ: Author.

This brief discusses three issues for state policymakers to consider as they implement strategies to address social determinants of health and aim to integrate such efforts into delivery of health care. Namely, state officials should consider: 1) covering selected non-medical services; 2) integrating social supports into health plan care management; and 3) using value-based payments… Read more »

Powers, M. (2018). The community’s emerging role in value-based health and social services. Generations: Journal of the American Society on Aging, 2018(Spring), 4-9.

This article examines how healthcare organizations are exploring closer partnerships with community-based organizations (CBOs), especially for high-need, high-cost populations. Social determinants of health are known to impact health outcomes, and there is growing recognition that non-medical services are as important as those received in a provider’s office. The article describes payment methods for these populations,… Read more »

Oostra, R., & Zuckerman, D. (2018, May). Embracing an anchor mission: ProMedica’s all-in strategy. Toledo, OH and Washington, DC: ProMedica and The Democracy Collaborative.

This report describes ProMedica’s (a mission-based, not-for-profit healthcare organization serv- ing northwest Ohio and southeast Michigan) shift to an Anchor Mission. This mission is embedded in an overall strategy related to addressing the social determinants of health as a whole. With that in mind, ProMedica has made a commitment to apply its economic power and… 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 »

Machledt, D. (2017, November 29). Addressing the social determinants of health through Medicaid managed care. Washington, DC: The Commonwealth Fund.

This brief explores the impact of several provisions of the Centers for Medicare and Medicaid 2016 updated Medicaid managed care rule’s influence states’ ability to address social determinants of health through managed care. Several provisions in the new Medicaid managed care rule signal CMS’s intent to increase access to high?value nonmedical interventions. For instance, the… 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 »

Georgia Health Policy Center & Robert Wood Johnson Foundation. (2016, October). Financing population health: abridge version. Atlanta, GA: Andrew Young School of Policy Studies, Georgia State University.

This report describes innovations in financing that can be used to improve population health. Eight innovations are described, with examples of each provided: 1) capture and reinvest; 2) blending and braiding; 3) community development financial institutions; 4) hospital community benefits; 5) low-income housing tax credits; 6) new market tax credits; 7) social impact bonds; and… Read more »

Felland, L., Lipson, D., & Heeringa, J. (2018, April). Examining New York’s Delivery System Reform Incentive Payment demonstration: Achievements at the demonstration’s midpoint and lessons for other states. Baltimore, MD: Centers for Medicare and Medicaid Services.

This brief examines New York’s Delivery System Reform Incentive Payment (DSRIP) demonstration. This demonstration, authorized by a Medicaid section 1115 waiver, is an ambitious and complex effort to transform the health care delivery system, reduce cost growth, and improve care outcomes for Medicaid beneficiaries and uninsured individuals. The demonstration involves thousands of health care providers… Read more »

Daniel-Robinson, L, & Moore, J.E. (2019, January). Innovation and opportunities to address social determinants of health in Medicaid managed care. Washington, DC: Institute for Medicaid Innovation.

This article identifies opportunities within the Medicaid program to identify and address the unmet social needs and risk factors that have a significant impact on health outcomes and costs. With access to enrollee health data, Medicaid managed care organizations (MMCOs), with the support of state Medicaid agencies and community-based organizations (CBOs), are well positioned to… Read more »

Crumley, D., Lloyd, J., Pucciarello, M., & Stapelfield, B. (2018). Addressing social determinants of health via Medicaid managed care contracts and section 1115 demonstrations. Hamilton, NJ and Washington, DC: Center for Health Care Strategies, Inc. & the Association for Community Affiliated Plans.

This report examines Medicaid managed care contracts or requests for proposals (RFPs) in 40 states, in addition to 25 approved section 1115 demonstrations. Incentives and requirements related to the social determinants of health (SDH) are compiled, common themes in the states’ approaches are identified, and recommendations are developed for federal policymakers, including the Centers for… Read more »

Cantor, J., Mikkelsen, L., Simons, B., & Waters, R. (2013, January). How can we pay for a healthy population? Innovative new ways to redirect funds to community prevention. Oakland, CA: Prevention Institute.

In this brief, four promosing approaches for sustainably generating resources to pay for community prevention within and outside the health care system are described: wellness trusts, social impact bonds/health impact bonds, community benefits from non-profit hospitals, and Accountable Care Organizations. These approaches represent those that stood out based on a broad scan of the academic… Read more »

Bachrach, D., Guyer, J., Meier, S., Meerschaert, J., & Brandel, S. (2018, January 31). Enabling sustainable investment in social interventions: A review of Medicaid managed care rate-setting tools. Washington, DC: The Commonwealth Fund.

This article explores practical strategies that states can deploy to support Medicaid managed care plans and their network providers in addressing social issues using a literature review, interviews with stakeholders, and analysis of federal regulations. The following strategies were identified: 1) classify certain social services as covered benefits under the state’s Medicaid plan; 2) explore… Read more »

Artiga, S., & Hinton, E. (2018, May). Beyond health care: The role of social determinants in promoting health and health equity. Menlo Park, CA: The Henry J. Kaiser Family Foundation.

This brief provides an overview of social determinants of health and emerging initiatives to address them. It shows: 1) social determinants of health include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care; 2) there are a growing number of initiatives to address… Read more »

American Hospital Association. (2019, January). Medicaid financing for interventions that address social determinants of health. Chicago, IL: Author.

This paper is intended to inform hospitals and health systems about these opportunities as they work with state Medicaid agencies, policymakers and health plans on ways to make financial support available for promising interventions. Medicaid financing can be an important source of support, though it is only one part of the puzzle. This paper identifies… 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 »

Hacke, R., Deane, K.G., & Schwarz, D. (2017, March). Improving community health by strengthening community investment. Cambridge, MA: Center for Community Investment.

This brief examines how community investment community Investment, as a sector, positions itself to confront social determinants of health deficiencies that are the result of market failures. The authors conducted hundreds of interviews with stakeholders from community organizations, government agencies, foundations, banks, and nonprofits. Additionally, a literature review was conducted that looked more broadly at… Read more »

Barr, P. (2015). Public partners in population health. Hospitals and Health Networks, 89(4), 34-37.

This article discusses how the the Accountable Care Act provision of community health assessments has prompted more cooperation between nonprofit hospitals, public health departments, and other community organizations. The article focuses primarily on public health departments. Driven by the increasingly shared vision of managing population health, officials for hospitals and public health departments are working… 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 »

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 »

United States Centers for Medicare and Medicaid Services. (n.d.). How do Medicare Advantage plans work? [Website].

This website describes Medicare Advantage plans. Medicare Advantage plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If a person joins a Medicare Advantage Plan, they will still have Medicare: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage will come from the Medicare Advantage… Read more »

The Kresge Foundation. (2017). Integration of health and human services [Website].

This website provides and overview of one area of the Kresge Foundation’s Health Program, the integration of health and human services. This program area seeks to: demonstrate models of integration that impact the health and well-being of families and children through an efficient, effective and seamless system of service; build infrastructure, policies and practices within… Read more »

National Human Services Assembly. (2018). National Reframing Human Services Initiative [Website].

This is the website of the National Reframing Human Services Initiative. This initiative seeks to build broader and deeper public support for human services so that everyone has the opportunity to reach their full potential. The website provides resources related to the initiative, including tools, publications, implementation guides to help to help organizations, associations, and… 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 »

The Annie E. Casey Foundation. (2014). Creating opportunity for families: A two-generation approach. Baltimore, MD: Author.

Nearly half of the nation’s families with young children struggle to make ends meet. This policy report makes the case for creating opportunity for families by addressing the needs of parents and their children simultaneously. Creating Opportunity for Families: A Two-Generation Approach describes a new approach to reducing poverty, which calls for connecting low-income families… Read more »

Homer, C. (2017, June 16). Human services help communities make the most of safety net programs [Web log post].

This blog posts considers how to move beyond questions of how to increase access to and quality of health care services to consider health system transformation in communities as a strategy to achieve better health. Community transformation can only occur when the federal and state policies on which communities can build are aligned. Human services… Read more »

Boris, E.T., de Leon, E., Roeger, K., & Nikolova, M. (2010). Human service nonprofits and government collaboration: Findings from the 2010 National Survey of Nonprofit Government Contracting and Grants. Washington, DC: Urban Institute.

This report explores the results of the 2010 National Survey of Nonprofit-Government Contracting and Grants, a study of human service organizations designed to document the extent of nonprofit-government contracting, processes and problems. It also examines the impact of the recession on these organizations and the cutbacks they have made to keep their programs operating. While… Read more »

Hester, J. A., Auerbach, J., Seeff, L., Wheaton, J., Brusueals, K., & Singleton, C. (2016). CDC’s 6|18 Initiative: Accelerating evidence into action. Washington, DC: National Academy of Medicine.

This paper presents a conceptual framework for the 6|18 Initiative and summarizes the criteria and process for selecting the 6 conditions and 18 interventions. Next, it describes how the CDC is building deeper partnerships: one with eight state Medicaid programs through the creation of a learning collaborative, and the second with a group of private… Read more »

American Public Human Services Association. (2018). National Collaborative for Integration of Health and Human Services [Website].

This is the website for the National Collaborative for Integration of Health and Human Services. APHSA’s National Collaborative for Integration of Health and Human Services (National Collaborative) drives innovation through the horizontal integration of the health and human services system. It promotes a system anchored in seamless, streamlined information exchange, shared services and coordinated care… Read more »