While the headlines focus on the latest twists and turns of health care politics and policies, a tectonic shift is happening in America’s approach to health, with innovations that show promise in terms of better outcomes, better quality of care, and lower costs.
Health care organizations and community-based providers of human services are now collaborating to address the crucial social—as well as the clinical—determinants of health. This movement recognizes the important role that factors like housing, food security, education, employment, and so forth play in the overall well-being of people and communities. It takes into account the costs of failing to address these factors, such as the impact of homelessness on emergency department (ED) usage. And it has been accelerated by developments like the Affordable Care Act and new payment and delivery models, such as accountable care organizations and value-based contracting.
This year, as part of its ongoing efforts to build a Culture of Health in communities across the country, the Robert Wood Johnson Foundation supported an effort to get a clear and current picture of this dynamic landscape—to capture, analyze, and share widely what kinds of partnerships exist among which partners, what’s working well, and what could work better.
The Partnership for Healthy Outcomes, which includes Nonprofit Finance Fund, the Center for Health Care Strategies, and the Alliance for Strong Families and Communities reached out to partnerships across the United States. Those that responded to the Request for Information included more than 200 organizations that are members of partnerships serving one or more of all fifty states. Key findings from the data have just been published here and will be augmented later this summer by four detailed case studies of partnerships serving varied populations and geography.
Here is a snapshot of what we have learned to date.
We and our partners knew, anecdotally, of numerous partnerships between health care organizations and community-based human services nonprofits.
We found a deepening and diverse array of partnerships of many sizes, shapes, motivations, and contractual and funding arrangements—with partners ranging from public health and other government agencies to private insurers, foundations, dental clinics, food banks, supermarkets, and more.
We knew that many partnerships had been formed to improve health outcomes and contain costs.
We found that most partnerships today focus on services targeting immediate goals such as lower ED usage, fewer hospital readmissions, shorter hospital stays, and transitioning patients from acute care to more appropriate and cost-effective settings. Many partnerships provide care coordination and clinical support. Fewer partnerships provide services that directly address social determinants of health with the goal of improving health in the long term.
We knew that there is an almost universal priority of more effectively deploying limited resources.
We found that 65 percent of partnerships reported cost savings. Community-based organizations, health care organizations, and other partners also reported expanded organizational skills and capabilities. In other words, they are expanding their professional networks, learning data systems, and building cultural competencies. These make for stronger partners as well as stronger partnerships.
We knew that we were asking questions in largely uncharted territory and that “we don’t know what we don’t know.”
We found that this growing movement needs clarity of language (talking at cross-purposes costs productivity) and that success depends on clearly identifying, articulating, and funding the full costs of launching and developing effective partnerships.
We knew that this effort is, at its heart, all about people.
We found that relationships, good communication, and trust—between and among providers, funders, and, crucially, the communities they serve—are absolutely key to successful partnerships and need attention and investment up front and throughout their existence.
The only certainty about the US health care landscape is that more change is coming. In this learning-while-doing moment, as we and others dig deeper into the operational, cultural, capacity-building, and other ingredients for effective partnerships, we must all remain open and nimble to respond, in real time, to what we learn, as well as to changes in policy and funding environments.
The Partnership for Healthy Outcomes, a year-long project of Nonprofit Finance Fund, the Center for Health Care Strategies, and the Alliance for Strong Families and Communities with generous support from the Robert Wood Johnson Foundation, captured and shared insights from partnerships between health care and community-based organizations, particularly those that serve low-income and/or vulnerable populations.
“Integrating Medical And Social Services: A Pressing Priority For Health Systems And Payers,” by Melinda K. Abrams and Donald Moulds of the Commonwealth Fund, July 5, 2016, GrantWatch section of Health Affairs Blog.