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 »
rwjf-tag: Role of government
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 »
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 »
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 »
Durovich, C.J., & Roberts, P.W. (2018). Designing a community-based population health model. Population Health Management, 21(1), 13-20.
This article outlines a suggested road map and practical considerations for health systems that are building or planning to build population health capabilities to meet the needs of their local markets. Traditional core capabilities needed to address the medical determinants of health for a population are reviewed. An innovative approach to community service integration to… 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 »
Bush, M. (2018). Addressing the root cause: Rising health care costs and social determinants of health. North Carolina Medicine Journal, 79(1), 26-29.
This article describes how North Carolina plans to use its Medicaid expansion to address social determinants of health. The expanded Medicaid is designed to convert North Carolina’s fee-for-service program into a managed care health delivery system, with managed care organizations (MCOs) controlling costs by managing overall population health for beneficiaries through lump sum payments that… 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 »
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 »
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 »
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 »
Dzau, V.J., McClellan, M.B., McGinnis, J.M., Burke, S.P., Coye, M.J., Diaz, A., … Daschle, T.A. (2017). Vital directions for health and health care: Priorities from a National Academy of Medicine initiative. Journal of the American Medical Association, 317(14), 1461-1470.
This article sought to review the most salient health challenges and opportunities facing the United States, to identify practical and achievable priorities essential to health progress, and to present policy initiatives critical to the nation’s health and fiscal integrity. Through a qualitative synthesis of the National Academy of Medicine white papers, authors found that the… Read more »
Moody, G. (2012). Ohio Health and Human Service Transformation. Presentation to the Center for Evidence Based Practice, Case Western University.
This presentation outlines Ohio’s plan for health and human service transformation under the ACA. Ohio’s vision includes: creating a person‐centered care management approach – not a provider, program, or payer approach; services are integrated for all physical, behavioral, long‐term care, and social needs; services are provided in the setting of choice; services are easy to… Read more »
National Association of Counties. (2017). Medicaid and Counties: Understanding the program and why it matters to counties [Presentation].
This presentation outlines why Medicaid matters to counties, the basics of Medicaid, the county role in funding and delivering Medicaid, Medicaid in the 115th Congress, and key messages for advocacy.
Fraser, M., & Castrucci, B. C. (2017). Beyond the Status Quo: 5 Strategic Moves to Position State and Territorial Public Health Agencies for an Uncertain Future. Journal of Public Health Management and Practice, 23(5), 543–551.
In this article, the authors propose 5 key strategic moves that leaders of state and territorial health associations (SHAs) can take to assure optimal health for all. The authors posit that despite new investments in health care delivery that incentivize payers and providers to promote population health, SHAs are the true “accountable care organizations” in… 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 »
Twombly, E. (2003). What Factors Affect the Entry and Exit of Nonprofit Human Service Organizations in Metropolitan Areas? Nonprofit and Voluntary Sector Quarterly, 32(2), 211-235.
The goal of this article is to advance the literature on nonprofit organizational adaptation by assessing the factors that significantly contribute to the entry and exit of human service organizations in metropolitan areas. More specifically, this study uses nonprofit, economic and demographic data and information on welfare reform implementation patterns to examine the causes of… 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 »
Brown, C., & Cintron, L. (2016). The New Brunswick Ciclovia evaluation report. New Brunswick, NJ: The Alan M. Voorhees Transportation Center.
This report documents and evaluates the overall success and effectiveness of New Brunswick’s first Ciclovia, an event where roads are closed to motorized vehicle to create a free-form event that welcomes participants of all ages and abilities to enjoy physical activity and recreation in a safe and inclusive environment. The research team collected data by… Read more »
Boris, E.T., de Leon, E., Roeger, K.L., & Nikolova, M. (2010). Contracts and grants between human service nonprofits and governments. Washington, DC: Urban Institute.
This brief summarizes 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 contracting… Read more »
Sandberg, S.F., Erickson, C., Owen, R., Vicerky, K.D., Shimotsu, S.T., Linzer, … DeCubellis, J. (2014). Hennepin Health: A safety-net accountable care organization for the expanded Medicaid population. Health Affairs, 33(11), 1975-1984.
This article examines Hennepin Health, a health system which place places all participants in a full risk-sharing agreement. Key to Hennepin’s success (improved health outcomes, reduced costs) was their investment in their healthcare workforce; leadership and collaboration; and a favorable policy environment within the state. Medicaid program rules limited what Hennepin is able to fund… 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 »
The Menges Group. (2014, June). Positively impacting social determinants of health: How safety net health plans lead the way. The Association for Community Affiliated Plans.
This report seeks to follow the five key areas of social determinants as outlined by Healthy People 2020, an initiative by the Department of Health and Human Services. The report describes programs in which the Association for Community Affiliated Press (ACAP) health plans are innovatively and positively impacting the other key areas of social determinants… Read more »
Shrimali, B., Luginbuhl, J., Malin, C., Fournoy, R., & Siegel, R. (2014). The building blocks collaborative: Advancing a life couse approach to health equity through multi-sector collaboration. Maternal and Child Health Journal, 18(2), 373-379.
This article describes the “Building Blocks Collaborative (BBC)” launched by the Alameda County Public Health Department (ACPHD) in California. The program focuses on young children in low income communities and was developed to improve health equity by improving community conditions that affect health and focusing on certain developmental periods in a child’s life. The authors… 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 »
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 »
The Kaiser Commission on Medicaid and the Uninsured. (2015, September). The State Innovation Models (SIM) program: A look at round 2 grantees. Menlo Park, CA: Author.
This report reviews State Innovation Model Round 2 programs and describes states as uniquely well-positioned to lead multi-payer efforts because of their role as major purchasers of healthcare services via Medicaid, CHIP, and also in insuring state employees.
Wachino, V. (2015, June 26). Coverage of housing-related activities and services for individuals with disabilities (CMCS informational bulletin). Washington, DC: Centers for Medicaid and CHIP Services.
This bulletin informs states that the Accountable Care Act is intended to help provide long-term services and supports, housing supports, and related activities.
Corrigan, J., Fisher, E., & Heiser, S. (2015). Hospital community benefit programs increasing benefits to communities. Journal of the American Medical Association, 313(12), 1211-1212.
In this viewpoint, the authors suggest that a modest reorientation of Hospital Community Benefit Programs (HCBPs) could help accelerate the development of successful regional health improvement initiatives. This article argues that delivery reforms alone cannot produce the cost savings required to sustain the healthcare industry; the industry must address the social determinants of health. HCBPs… Read more »
Segal, L.M., De Biasi, A., Lieberman, D.A., Olson, G., & Ilakkuvan, V. (2016, October). Blueprint for a health America 2016: Policy priorities for the next administration and Congress. Washington, DC: Trust for America’s Health.
This report highlights high-impact policies that could help spare millions of Americans from preventable health problems and save billions in avoidable healthcare costs. The report highlights pressing crises and how investments could yield positive returns on investment by adopting proven health strategies. The Blueprint highlights leading evidence-based strategies for improving health and policy – and… Read more »
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 »
Kottke, T.E., Stiefel, M., & Pronk, N.P. (2016). Well-being in all policies: Promoting cross-sectoral collaborations to improve people’s lives. Preventing Chronic Diseases, 14(13), E52.
In this article, the authors suggest that in the US the expression “well-being in all policies” be used instead of “health in all policies.” The authors argue that adopting this convention could avoid the problems caused when health care policy is conflated with health policy. It may also increase the willingness of policy makers in… Read more »
Huang, T. J. (2016). Partnerships between local health departments and community health centers in pursuit of the Triple Aim. Washington, DC: National Association of County & City Health Officials.
This research brief and the project it summarizes represent an effort by the National Association of County and City Health Officials (NACCHO) to contribute to that understanding and sharing of information. This research brief provides information on current collaborations between local health departments (LHDs) and community health centers (CHCs) to inform community, state, and national… Read more »
Moses, K., Hamblin, A., & Somers, S. (2016, January). Supportive housing for chronically homeless Medicaid enrollees: State strategies. Hamilton, NJ: Center for Health Care Strategies.
In July 2015, the Center for Health Care Strategies (CHCS) convened state Medicaid officials; federal policymakers from the Department of Health and Human Services, the Department of Housing and Urban Development, the Office of Management and Budget, and the United States Interagency Council on Homelessness; and experts in the fields of managed care, housing, and… 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 »
Partnership for Healthy Outcomes. (2017, October). Using Medicaid levers to support health care partnerships with community-based organizations. Hamilton, NJ: Author.
This fact sheet outlines strategies to help Medicaid officials encourage partnerships between community-based organizations and health care organizations, including financial, metrics, incentives, and policy levers.
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 »