rwjf-tag: Publicly Available

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 »

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 »

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 »

Bachrach, D., Guyer, J., & Levin, A. (2016, July). Medicaid coverage of social interventions: A roadmap for states. New York, NY: Milbank Memorial Fund.

This issue brief is a practical guide for policymakers who want to know when and how states can use Medicaid to facilitate access to social services. It offers a road map of the legal authorities upon which policymakers can rely to extend Medicaid coverage to social interventions and provides examples of how Medicaid can be… Read more »

McGinnis, T., Bonney, J., & Chang, D. (2018). Innovative Medicaid payment strategies for upstream prevention and population health. Washington, DC: Academy Health, Robert Wood Johnson Foundation, & Nemours Children’s Health System.

This report describes a partnership between Nemours Children’s Health System and Maryland, Oregon, and Washington, to test how Medicaid payment authorities and new payment models could be used to support interventions to address the social determinants of health using a previously developed Medicaid Roadmap. This report illustrates the possibilities for using current Medicaid authority to… Read more »

Raday, S., Krodel, N., & Chan, A. (2018). Human services organizations: Partnering for better community health. New York, NY: Nonprofit Finance Fund. 

This report describes the Healthy Outcomes Initiative, which explored how community-based human services organizations can partner and integrate with health systems, insurers, and government to propel large-scale improvements in the health of America’s communities. Nonprofits and other community-based human services organizations are needed to provide the basic building blocks for health.

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 »

Partnership for Healthy Outcomes. (2017, October). Collaborating to reduce hospital readmissions for older adults with complex needs: Eastern Virginia Care Transitions Partnership. Hamilton, NJ: Author.

This report is a case study of the Eastern Virginia Care Transitions Partnerships. The partnership in southeastern Virginia was designed to reduce hospital readmissions and improve quality of care among older adults and those with complex illness through an evidence-based care transition model and in-home assessments. This unique collaborative effort was a large-scale partnership including… Read more »

Murphy, T. & Majerol, M. (2017). Mindful Medicaid: Nudging expectant mothers and children toward preventative care. Deloitte Center for Government Insights.

This article discusses the importance of preventative or upstream interventions from the perspective of pre-term births and their prevalence in the United States. Authors identify techniques such as choice-architecture to adjust patient behaviors towards predefined optimums, commitment devices and reminders as programmatic tools to ensure predefined choices are adhered to and carried out, and social… Read more »

Kohli, J., & De Biasi, A. (2017). Supporting healthy communities: How rethinking the funding approach can break down silos and promote health and health equity. The Deloitte Center for Government Insights.

This report presents the findings of a collaborative study by the Trust for American’s Health and Monitor Deloitte. A series of expert interviews and workshops were conducted in 2016 with the aim of identifying ways to leverage the growing focus on social determinants of health and increase in value-based incentive structures to move toward a… Read more »

Magnan, S. (2017, October 9). Social determinants of health 101 for health care: five plus five. Washington, DC: National Academy of Medicine: HealthPartners Institute & University of Minnesota.

In this article, the author articulates five things we know and five things health care organizations need to learn to address social determinants of health for the national quality strategy. The authors acknowledge that critics are right to question how we address yet another issue in health care. However, organizations can define (and circumscribe) their… Read more »

Rosenbaum, S., Riley, T., Bradley, A.L., Veghte, B.W., & Rosenthal, J. (2017). Strengthening Medicaid as a critical lever in building a culture of health. Washington, DC:  National Academy of Social Insurance.

This report argues that Medicaid functions as a key economic engine, anchoring health care services in communities., and an important entry-point for human/social services. As Medicaid expands it gains leverage to direct changes in how healthcare services are delivered. Medicaid faces several challenges including: 1) poverty and an aging population; 2) cost of transformation; 3)… Read more »

Clemans-Cope, L., Wishner, J.B., Allen, E.H., Lallemand, N., Epstein, M., & Spillman, B.C. (2017). Experiences of three states implementing the Medicaid health home model to address opioid use disorder: Case studies in Maryland, Rhode Island, and Vermont. Journal of Substance Abuse Treatment, 83, 27-35.

This study examines state approaches to opioid health homes (OHH) and uses a retrospective analysis to identify facilitators and barriers to the program’s implementation from the perspectives of multiple stakeholders. Three states-Maryland, Rhode Island, and Vermont – adopted the ACA’s optional Medicaid health home model for individuals with opioid use disorder. The model coordinates opioid… Read more »

Partnership for Healthy Outcomes. (2017). Housing is a health intervention: transitional respite care program in Spokane. Hamilton, NJ: Author.

This report is a case study of a transitional respite care program that uses recouperative care beds provided by homeless shelter for local hospital to which to discharge homeless post-op patients. The Transitional Respite Care Program (Respite Program) in Spokane, Washington, is a collaboration among Catholic Charities Spokane, Providence Sacred Heart Medical Center (part of… 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 »

Paradise, J., & Ross, D.C. (2017, January). Linking Medicaid and supportive housing: Opportunities and on-the-ground examples. Menlo Park, CA: The Henry J. Kaiser Family Foundation.

This issue brief outlines ways in which Medicaid can support integrated strategies and, based on telephone interviews with key informants, profiles three current initiatives that illustrate distinctly different approaches to linking Medicaid and supportive housing. The three initiatives include one launched by a city (Philadelphia), one by a state (Louisiana), and one by a Medicaid… Read more »

Partnership for Healthy Outcomes. (2017, October). Ensuring healthy outcomes for Louisville’s vulnerable children: Health access nurturing development services program. Hamilton, NJ: Author.

This report describes a public health and community-based partnership in Kentucky which reduced the rate of pre-term births, and decreased Child and Protective Services encounters. Lessons learned from this partnership were that: collaboration and leadership are key; cultural change is required for reform; and Medicaid funding rules limit funding to non-first-time-mothers.

The Scan Foundation. (2017, October). Top 10 recommendations to strengthen integrated care: Lessons from California’s dual eligible demonstration. Long Beach, CA: Author.

This brief describes recommendations to integrate health and human services. These recommendations include: integrating medicaid/medicare into a single health plan has benefits for beneficiaries; health plans need to use all available information and tools at their disposal; affordable housing is key to transitioning people from healthcare settings to the community; value based payment efforts will… 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 »

Haber, S., Beil, H., Adamache, W., Amico, P., Beadles, C., Berzin, O., … Wright, A. (2017). Evaluation of the Maryland all-payer model. Waltham, MA: RTI International.

This report describes findings from the first 2 years of the evaluation of the All-Payer Model in Maryland. The report covers 2 1/2 years of the implementation of the All-PayerModel, focusing on the most recent year (July 2015–June 2016) and outcomes for 2 years for fee-forservice Medicare beneficiaries (January 2014– December 2015). The evaluation of… 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 »

Walker, B.J., & Fishman, T.D. (2015). Rethinking human services delivery: Using data-driven insights for transformational outcomes. Deloitte.

This report argues that human service programs should be redesigned to serve customer segments, rather than administer services. Data-programs should be transformed through analytics in order to identify and address the problems that bring individuals and families into contact with the social safety net instead of through the lens of eligibility that only provides a… Read more »

Rosenbaum, S., Gunsalus, R., Velasquez, M., Jones, S., Rothenberg, S., & Beckerman, J.Z. (2018, March). Medicaid payment and delivery reform: Insights from managed care plan leaders in Medicaid expansion states. Washington, DC: The Commonwealth Fund.

In this brief, the authors aim to understand MCO experiences in Medicaid expansion states and learn about innovations related to access to care, care delivery, payment, and integration of health and social services to address nonmedical needs. Through interviews with leaders of 17 Managed Care Organizations (MCOs) in 10 states that have seen large Medicaid… Read more »

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

This report offers practical guidance that incorporates feedback from the field to providers and payers to help them get started on the integration of social determinants as part of their core business. Through case study analysis, the authors find that initial social service investments have the potential to yield high financial returns within a time… Read more »

Griffin, K., Nelson, C., Realmuto, L., & Weiss, L. (2018). Partnerships between New York City healthcare institutions and community-based organizations: A qualitative study on processes, outcomes, facilitators, and barriers to effective collaboration. NY: Greater New York Hospital Association/The New York Academy of Medicine.

The report describes findings from a research project in which focus group and interview participants from New York City-based hospitals, Delivery System Reform Incentive Payment (DSRIP) program Performing Provider Systems (PPSs), and community-based organizations (CBOs) discuss partnering experiences, processes, successes, and challenges. Although the research focused on New York City partnerships, the findings are broadly… 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 »

WellCare Health Plans. (2018). New study shows how managed care organizations can help address social determinants of health with new social-support role [Press release].

This press release announces new research released by WellCare Health Plans, Inc. and the University of South Florida and published in The American Journal of Accountable Care that examined how WellCare CommUnity Liaisons, a new social-support person role, effectively used their own personal experiences to provide social support to study participants (callers) experiencing a broad… Read more »

The Human Services Council of New York Commision on Value-Based Care. (2018). Integrating health and human services: A blueprint for partnership and action. New York, NY: Author.

The New York Human Services Council (HSC) convened the Commission on Valuebased Care to examine and inform the State’s health care reform efforts with a human services CBO lens. Over the course of a year, this group of leaders with experience and expertise spanning government, health care, philanthropy, academia, and human services explored areas including… Read more »

Morris, G., Roberts, D., Leis, H., Mehring, A., Cederberg, C., Shahid, N., … Cavagnero, J. (2018). A national imperative: Joining forces to strengthen human services in America – 2018. New York, NY: Oliver Wyman, SeaChange Capital Partners, Alliance for Strong Families and Communities, and the American Public Human Services Association.

This report started because of a growing concern about the financial health of community-based organizations (CBOs) which deliver human services. The project was designed to assess the financial health of the human services CBOs, identify underlying causes that lead to financial vulnerability, and to propose ways to make them stronger. The objective was to provide… Read more »

McGuire, J. (2016). Population health investment by health plans and larger provider organizations: Exploring the business case. Boston, MA: Northeastern University.

This report had two objectives: 1) To determine if there is a business case for the population health investments made by health plans and large provider organizations; and, if so, 2) To understand how business interests inform decision-making and affect the outcomes of population health investments. The author conducted an exploratory study composed of a… Read more »

Brooks, T., & Whitener, K. (2018). Leveraging Medicaid to address social determinants and improve child and population health. Washington, DC: Georgetown University.

This brief is intended to ground health care advocates on social determinants of health (SDOH) basics and describe ways Medicaid, in partnership with the health plans and providers that deliver public coverage benefits, can improve the health of enrollees by addressing the SDOH. It provides background and highlights resources that can support advocacy efforts to… Read more »

Easterling, D., & McDuffee, L. (2018, March 14). Finding leverage over the social determinants of health: Insights from a study of 33 health conversion foundations. Winston-Salem, NC: Wake Forest School of Medicine.

This article analyzed the strategic frameworks of 33 conversion foundations from throughout the US that have a reputation for addressing social and economic issues through interviews with foundation leaders. Authors identified five strategic pathways for improving social and economic condition that ranged from improving existing institutions to changing who has political power, and argue that… Read more »

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 »

Garrett, D., Hwang, A., & Pierce-Wrobel, C. (2018, May 30). Social determinants of health: A public health concept in conflict [Web log post].

This post discusses Centers for Medicare and Medicaid Services’ approval of states adding a work requirement as a condition of receiving Medicaid coverage, and the negative impact that is likely to have on citizens’ health outcomes. States are cautioned to be careful about implementing policies that may sound relevant to social determinants but will ultimately be… Read more »