Striving Toward a Culture of Health: How Do Non-Medical Needs Factor into Alternative Payment Models? Topic Profile: Alignment Across Sectors – Multi-sector Care Delivery AcademyHealth and the Network for Regional Healthcare Improvement hosted a two-day workshop, “Striving Toward a Culture of Health: How Do Non-Medical Needs Factor into Alternative Payment Models?”, which convened five multi-sector teams, comprised of health care sector and non-health care sector partners, and led by regional health improvement collaboratives. The workshop provided information from content experts and fostered shared learning across communities to inform next steps in their own specific community-based collaborative projects. The workshop focused on four key topic areas and the related barriers that potentially influence the conditions and collaborations necessary to support non-clinical community-wide population health services. This profile highlights one of these topic areas, the issue of multi- spurred discussion on how that care delivery model could be ex- sector care delivery, along with barriers and lessons learned from the panded and supported to integrate non-clinical community services workshop. The session highlighted lessons learned in the last decade into those clinically-focused models. about transforming care delivery, particularly in primary care, and Emerging Issues Workshop participants discussed many issues that should be consid- ered by multi-sector collaborative partners when addressing multi- sector clinical and non-clinical care delivery integration. Establishing mutual understanding of how care is currently delivered among partners in a community – as well as who the key providers are – was integral to the conversation. In particular, meeting participants iden- tified a fundamental need to understand the following: • Who are the key providers of clinical services and social services in the community? • How are health care and social services currently delivered among the partners/community? Community First, Hilo, Hawaii • What key clinical and non-clinical care delivery interventions Greater Detroit Area Health Council, Detroit, MI do the collaborative partners want to undertake? Health Care Improvement Foundation, Philadelphia, PA The Health Collaborative, Cincinnati, OH • How can social services be integrated and coordinated Washington Health Alliance, Seattle, WA with clinical services? Genesis of this Brief: With support from the Robert Wood Johnson Foundation, AcademyHealth’s Payment Reform for Population Health (P4PH) initiative aims to develop a comprehensive understanding of current efforts and successes related to payment reform activities that support community-wide (i.e., geopolitically-based) population health improvement. To inform this effort, AcademyHealth collaborated with the Network for Support for this program was provided by the Robert Regional Healthcare Improvement (NRHI) to explore challenges and barriers related Wood Johnson Foundation. The views expressed here to how health care purchasers, plans, and providers could support strategies for do not necessarily reflect the views of the Foundation. sustainable investment in non-clinical community-wide population health activities. Topic Profile: Alignment Across Sectors – Multi-sector Care Delivery • What are the desired shared outcomes/goals from these multi-sector interventions? Lessons Learned • How can the quality and capacity of the social services sector • Start small. Identify practical interventions and data collection be ensured? activities to build trust and demonstrate proof of concept to • Can health care providers and social services organizations those participating in the collaborative. share financial risk for performance? • Invest in the planning process by equally involving health care and non-health care sector decision makers. Start with agree- Key Barriers Identified ment on where to focus. • Accountability – Collaborative partners must agree on who can be held ac- • Continue ongoing engagement to ensure commitment and countable and financially at-risk for multi-sector interven- leadership of collaborative partners. tions. Is responsibility and accountability shared? Do certain • Ensure data collection and analysis is credible for intervention’s partners have more responsibility than others? proof of concept by making it straightforward and consistent. • Power Dynamics – Collaborative partners must recognize and understand the • Collaborative partners should coordinate related programs to power dynamics and influence of certain partners that can make use of existing data tools, which can create momentum. negatively or positively affect the success of their efforts. • Use social determinants of health screeners to link individual • Maintain Involvement needs with community services. – Collaborative partners must commit and remain at the table to represent the full voice of the community. • Involve all collaborating partners in key decision-making. • Social Service Sector Capacity/Quality • Engage all payers to ensure care coordination is a “utility” for – Collaborative partners must assess the adequacy of commu- total community (i.e., limit “free riders”). nity-based organizations and social services to meet a poten- tial increase in referrals to address newly identified gaps and patient needs. – Collaborative partners must ensure that the quality of social services being delivered is sufficient. To learn more about these projects, visit www.academyhealth.org/p4ph About RWJF About AcademyHealth About NRHI For more than 40 years the Robert Wood AcademyHealth is a leading national The Network for Regional Healthcare Johnson Foundation has worked to organization serving the fields of health Improvement is a national organization improve health and health care. We are services and policy research and the representing regional multi-stakeholder working with others to build a national professionals who produce and use this groups working towards achieving better Culture of Health enabling everyone in important work. Together with its mem- health, better care, and reduced costs America to live longer, healthier lives. bers, AcademyHealth offers programs and through continuous improvement. NRHI For more information, visit www.rwjf.org. services that support the development and all of its members are non-profit Follow the Foundation on Twitter at and use of rigorous, relevant, and timely organizations, separate from state govern- www.rwjf.org/twitter or on Facebook at evidence to increase the quality, acces- ment, working directly with physicians, www.rwjf.org/facebook. sibility, and value of health care, to reduce hospitals, employers, health plans, and disparities, and to improve health. patients using data to improve health care. 2 | April 2017