This brief provides an introduction to screening for social risk factors, the first step most states are taking through their Medicaid managed care programs to address how social determinants of health influence enrollees' health status and spending.
This report features lessons learned from Arizona and Michigan and supplements earlier materials on building complex care programs and using a housing as health care approach for complex care populations.
This report examines examples from two state Medicaid programs and a nonprofit quality measurement and reporting organization of the data sources used to identify patients’ social risk factors when risk-adjusting payments or measuring quality.
This commentary features a conversation with health leaders in Colorado about how their agencies partnered to support families with young children during the COVID-19 pandemic, as well as the challenges they faced.
This brief highlights how Nebraska’s Medicaid agency and its Division of Public Health partnered to share antibiotic prescribing information between Medicaid claims and evaluation and management codes to determine where targeted education and outreach efforts were needed.
This commentary discusses the need for states to be sound stewards of taxpayer dollars and why the need to do so now is particularly acute as states confront financial landscapes devastated by the pandemic.
This commentary discusses the huge rise in the number of people without health insurance in the wake of mass layoffs resulting from the COVID-19 pandemic and are seeking strategies to protect them from high prescription drug prices.
This commentary discusses the use of Telemedicine during the COVID-19 pandemic. It summarizes the federal legislation and guidance and discusses actions state departments of insurance can take to encourage greater access to telehealth services.
This commentary includes examples of how states can address new needs, including housing, food, transportation, education, and employment, and how the CARES Act can support and amplify states' work to help stop the spread of COVID-19 and assist people with health-related social needs.
This commentary highlights the promise and challenge of telehealth tools, including unconventional uses of telehealth technology, scalability of interventions, the effect of patient preferences on behavior adoption, and the effect of patient demographics on adoption.
This post presents two sample hospital reporting templates to help policymakers capture the information they need to critically evaluate the community benefit investments hospitals make in exchange for their tax exemptions.
This report focuses on how Medicaid programs can use data from the American Community Survey (ACS), to inform and target interventions that seek to address social determinants of health and advance health equity.
This article examines Advancing Integrated Models (AIM), a project through which eight organizations are designing and piloting new strategies for integrating innovative, “next-generation” approaches to person-centered care for individuals with complex health and social needs.
This report gives an overview of the federal authorities under which states are able to cover nonclinical housing-related services for high-need Medicaid enrollees, and also details how states are using these authorities to invest in supportive housing for diverse high-need Medicaid populations.
In this podcast, Connecticut’s Medicaid director Kate McEvoy and chief financial officer Mike Gilbert discuss their experiences working with partners in the executive and legislative branches to build trust and a shared vision for sustaining critical programs.
This issue brief draws from the experiences of states that were among the first to implement their substance use disorder waivers to profile how the American Society for Addiction Medicine (ASAM) Criteria is used within the context of managed care and utilization review, and the challenges and best practices associated with its use.
This brief describes interviews with 10 Medicare Advantage plans, Medicare Advantage experts, and social service providers to discuss new benefits added under the Centers for Medicare & Medicaid Services' increased flexibility in plan year 2019.
This blog outlines how states like Oregon and Connecticut go beyond federal requirements to ensure that hospital community benefit spending is substantial, meets community needs, and addresses state goals in exchange for tax exemptions.
This interview features two physicians who participated in planning New Jersey’s statewide office-based addiction treatment program and their experiences treating addiction within primary and specialty care settings.
This webinar highlights how two providers operating in vastly different settings have incorporated a trauma-informed approach to care into their day-to-day practices for treating substance use disorder.
States can work to make sure hospitals truly seek out and act on meaningful input from a wide range of community representatives — not just community members on a hospital’s board or leaders from high-profile community groups.
This study analyzes three programs that use non-traditional workforce strategies to extend the reach of their clinics to better engage complex patients in their homes, at medical appointments, and other locations.
Several states are developing accountable health models to improve health and control costs by addressing health-related community needs, such as transportation, recreation, and housing. This brief examines their organizational and governance structures.
This commentary explores a series of case studies and tools developed after a national scan of promising HC/CBO partnerships that examine the operational, financial, and strategic components of successful partnerships.
This resource compares national and state-by-state data on the well-being of infants and toddlers, and provides national and state-level data to help advance policies to improve the lives of babies and families.
This brief explores opportunities to better address patients’ non-medical needs, including: identifying non-medical needs; employing non-traditional workers; partnering with community-based organizations/agencies; testing new technologies; and identifying funding.
This project encourages state, local, and national level organizations to include health considerations in policy decisions across multiple sectors, such as housing, transportation, and education. Research shows that the conditions in which people live, learn, work, and play influence their health, so the project also works to create cross-sector partnerships that include the expertise of health care and public health systems.
This tool helps identify policies and programs that are a good fit for community priorities. Analysts review and assess research to rate the effectiveness of a broad variety of strategies (i.e., policies, programs, systems & environmental changes) that can affect health through changes to: health behaviors, clinical care, social and economic factors, and the physical environment.
This case study explores how Indiana’s Family and Social Services Administration is working to rethink how to optimize the integration and delivery of health and social services for Medicaid beneficiaries.
The Minnesota State Employee Group Insurance Program has covered Minnesota state employees and their dependents using a tiered provider model since 2002. A recent SHARE-funded analysis examined the tiering model as well as patient and clinic responses to this tiered provider network approach.
Recognizing an unmet need for toiletries and household products among clients, AccessHealth Spartanburg stocks a closet where eligible clients can “shop” for items. This builds trusting relationships between clients and staff and meets basic client needs.
This webinar featured the use of admissions, discharge, and transfer (ADT) data feeds to coordinate care for patients with behavioral health and other complex care issues in Tennessee and Washington. It provided lessons learned, including operational and financing strategies, linkages to quality metrics and outcomes, and alignment with other statewide payment and delivery system efforts.
The Well-Being and Basic Needs Survey (WBNS) monitors changes in health and well-being at a time when policymakers seek significant changes to programs that help low-income families pay for basic needs. Most indicators based on data from the WBNS are reasonably consistent with measures from larger federal surveys.
As federal and state policymakers weigh changes to federal programs that help low-income people meet their basic needs for food, medical care and shelter, they run the risk of increasing material hardship, which could have detrimental short- and long-term impacts on children and adults.
This chart compares the social determinants 11 states targeted in their Medicaid contracts and contract guidance documents to enhance population health, as well as how states monitored outcomes and funded these efforts.
This report provides a compilation of data on equity goals and progress for 28 measures of health, socioeconomic factors, physical and social environment, and access to health care. Each measure is presented by race, ethnicity, and socioeconomic status for all 50 states, the District of Columbia, and the nation.
Informed by more than 30 key informant interviews representing programs in 19 states and a small group convening, this report offers a national analysis to uncover opportunities to facilitate state-level, cross-sector strategies that promote health beyond the traditional health care levers.
Six case studies on innovations in public health, including: Boston's PHC Bridges Sectors to Combat Overdoses; Chicago's DPH Sees the Future Thanks to Predictive Analytics; Hennepin County Uses Automation in Databook Development; Douglas' CHD Brings STD Testing to Youth-Friendly Locations; Portsmouth's HD Uses CASPER to Collect Neighborhood Data; and Check Out a Book, Check Out a Blood Pressure Kit.
This article explores efforts by nine state Medicaid and public health agency teams to implement 6|18 interventions related to asthma control, tobacco cessation, and unintended pregnancy prevention. It was published in the Journal of Public Health Practice and Management and covers Colorado, Georgia, Louisiana, Massachusetts, Michigan, Minnesota, New York, Rhode Island, and South Carolina.
State Medicaid programs are increasingly requiring their Medicaid managed care organizations (MCO) to implement APMs. It is important for states to develop ways to ensure that their MCOs are complying with the APM requirements within their contract, and monitoring the progress and challenges with the implementation of APM strategies with Medicaid providers. This report focuses on different ways in which states may set standard APM definitions to track MCO progress toward meeting state APM goals, and support comparison of APM implementation within a state and nationally.
The Health Care Payment Learning and Action Network Alternative Payment Models Framework (the LAN APM Framework) is an increasingly common method being used by states to measure plan progress toward implementation of APMs. This report provides real-world examples of APMs within the LAN categories and can help states and other interested purchasers develop a common understanding of what types of payment models fit within the framework categories.
This article details a qualitative analysis that (1) identified facilitators and barriers to utilizing a community health worker (CHW) model among patient-centered medical homes (PCMHs) in Minnesota; and (2) defined roles played by the CHW workforce within the PCMH team. Four themes emerged as facilitators and barriers: the presence of leaders with knowledge of CHWs who championed the model; a clinic culture that favored piloting innovation vs. maintaining established care models; clinic prioritization of patients' nonmedical needs; and leadership perceptions of sustainability.
This report examines how organizations participating in Transforming Complex Care (TCC), a multi-site national initiative funded by RWJF, are assessing and addressing social determinants of health for populations with complex needs. It reviews key considerations for organizations seeking to use SDOH data to improve patient care.
As the opioid and mental health crises continue to gain national attention, local leaders are stepping up to implement programs to address the prevalence and impact of untreated serious mental illness (SMI) and substance use disorders (SUD). This report explores how cities and counties have launched local initiatives to address the human and economic impact of untreated SMI and SUD.
State policy makers are increasingly focused on social determinants of health (SDOH) because of the important influence of these determinants on health care outcomes and Medicaid spending. Social determinants include a broad array of social and environmental risk factors such as poverty, housing stability, early childhood education, access to primary care, access to healthy food, incarceration and discrimination. This report digs into opportunities that states have to account for SDOH in Medicaid programs.
Mental health and substance use coverage could roll back to pre-Affordable Care Act (ACA) levels if the American Health Care Act (AHCA) becomes law. Analysis finds the AHCA could limit access to mental health treatment.
The “Buying Value Measure Selection Tool” was developed to assist state agencies, private purchasers and other stakeholders in creating aligned measure sets, and was first released in 2014. This webinar explains this tool and recent updates for state officials and other stakeholders involved in developing and maintaining aligned quality measure sets for health care entities and programs including for health plans, accountable care organizations, and patient-centered medical homes. This webinar presents strategies for selecting measures and reveals an updated version of the tool.
Health care leaders are well-positioned to use cross-sector approaches to drive improvements in population health in collaboration with state leaders. Through the use of joint measurement and accountability tools, policymakers can help to improve health outcomes to an extent not possible through isolated, medical-centric efforts. This report outlines how state agencies can use shared measurement and joint accountability across sectors as tools for improving population health outcomes.
This report describes six potential integration strategies that state agencies might employ to better integrate social services and health care delivery. For each, the report contains examples from several states that have utilized these strategies in their own efforts to increase integration.
In an era of public health system transformation, public health departments around the nation are adapting — or “modernizing” — to meet the growing and changing needs of their communities. To help states navigate the challenges inherent in public health system transformation, three grantee states are participating in a learning community supported by PHNCI. The three states — Ohio, Oregon and Washington — are working to test and implement the systems transformations required to provide the foundational public health services statewide and ensure that all residents have equitable access to public health.
Changes in population-based payment models in health care delivery have spurred enhanced efforts toward closer integration between state purchasers of health care and state, county, and local public health officials. This issue brief investigates approaches that state agencies might employ in order to better integrate public health and health care delivery as a means of improving health and the value of health care, and it is organized according to seven features of integration. The issue brief is accompanied by three case studies providing additional detail to some of the examples cited in the brief.