Invitation to Participate in a Feasibility Study To Learn How to Finance the Integration of Social and Health Services in Local Areas
Do you agree that we should be spending more money “upstream” to help people become and stay healthy rather than spending ever more money “downstream” to take care of them after they are sick? But have you noticed that our national, state, and even local spending priorities seem to be exactly the opposite? Well then you should consider joining this project.
Convincing research evidence shows that investments in housing, nutrition, and transportation, among other healthy opportunities (commonly known as social determinants of health), can improve health and other dimensions of well-being for vulnerable populations while reducing health care utilization and a variety of health and social service costs. Nevertheless, adequate and sustainable financing of healthy opportunities has eluded most if not all communities in the US. This project is designed to explore, teach, and learn about specific tactics to improve this situation.
It turns out that healthy opportunities’ investments have properties like other public goods which benefit many stakeholders simultaneously and unavoidably. These properties lead to “free-rider” problems and systemic underinvestment. In short, those who could benefit from investing upstream – for example hospitals who could reduce their own uncompensated care by helping the homeless — fear that part of the “return” from their investment would flow to those who did not invest (other hospitals), and so each invests too little, and then the total investment upstream in each community is far lower than it could or should be.
Our recent Health Affairs article showed that with a few tweaks a relatively obscure economic model – a Vickrey-Clarke-Groves auction – can help solve this type of free-rider problem that arises in a healthy opportunities context under certain conditions, namely, where reasonably collaborative stakeholders, relevant data, and a trusted information broker are available. The beauty of the model is that it is powered by local stakeholder self-interest, and thus financing solutions do not depend on ever more government or philanthropic spending. This makes the model more likely to be sustainable than existing financing alternatives. Given local reactions to the ACA’s readmissions penalties and to the opioid crisis, as well as states’ increased reliance on Medicaid MCOs, the key pre-condition for this model to be applicable – local stakeholder coalitions searching for collaborative solutions to common SDOH problems — is spreading. We infer this from the responses our paper has engendered from community stakeholder groups, individual members and local leaders from around the country. We are gratified and energized by these responses.
And now thanks to the generous support of the Commonwealth Fund, the Missouri Foundation for Health, the Episcopal Health Foundation, and the California Health Care Foundation, we are thrilled to be able to offer a no-cost tutorial in how this model and its attendant processes might be applied in your community. This invitation is open to any willing participant, whether you work for an existing coalition, health care provider or insurance organization, social service provider, local governmental unit such as a health or social service agency, mayor’s office or county government, employer coalition, community advocacy organization, philanthropy, faith based organization, state government, or a consultancy that facilitates the work of any or all of the above, potential stakeholders all.
The tutorial we have in mind is partly didactic in that we and our collaborators at the Altarum Institute will teach how the payment model would work and also explain the processes necessary to implement and evaluate it, including the mechanics of the economic model itself, coalition governance techniques, data generation, data sharing, vendor contracting and rigorous project evaluation requirements. But the feasibility study also entails a continuous and interactive process of mutual assessment, by us of local coalition and stakeholder capacities and commitment and by you of the model’s and processes’ potential applicability to healthy opportunities in your community with your existing or potential collaborators. This project is called a feasibility study literally because we and our funders will assess along with you the feasibility of implementing and testing the model in your communities in the coming months and years.
The project will be guided throughout by a national advisory panel with deep experience implementing collaborative work in health and social service arenas (learn more about them here). It will formally kickoff with 4 webinars (July 11, July 24, September 12, September 25; each from 2-3:30 pm EDT) that will be archived for viewing convenience and provide details of the model, governance considerations, lessons from the professional literature evaluating prior health opportunity interventions, data requirements, and demonstrations of the bidding, contract management, and data reconciliation processes necessary to sustain the model over time. Along the way we will assemble data on participants’ healthy opportunity environments, from publicly available data bases and from local Community Health Needs Assessments, as well as from local stakeholders yourselves. In the last quarter of 2019 and early 2020 we will conduct site visits to the communities among you that seem to be the most promising candidates for early implementation and testing. In early 2020 we will write a comprehensive report of lessons learned from this project about which community characteristics appear most conducive and which most challenging to the model’s applicability and implementation. Throughout the project but especially in the latter half of the 12-month feasibility project, we will help the willing among you to apply for funding to pay for the technical assistance to implement and evaluate your application of the model in your community. Finally, we will prepare implementation guides and tool kits for others to implement and evaluate the model over time as well.
In order to sign up for the feasibility study, please click here.
While the particular model we have developed with processes to implement may not be perfect for every locale or stakeholder group, and we will explain other financing alternatives as we go along, we believe our model has great promise for healthy opportunity situations in a wide variety of communities. Indeed, the range of communities, individuals and organizations that have already reached to us directly make this point. We hope you will allow us to help you learn about this model and assess its applicability to the healthy opportunity problems you and others like you face.
Len M. Nichols and Lauren A. Taylor