Striving Toward a Culture of Health: How Do Non-Medical Needs Factor into Alternative Payment Models? Topic Profile: Payment and Financing 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, issues related to Emerging Issues the payment and financing of non-clinical interventions, along Workshop participants discussed many issues related to the pay- with the barriers and lessons learned from the workshop. ment and financing of non-clinical population health interventions. Health care sector and non-health care sector partners expressed broad interest in understanding all financial components related to funding population health improvement activities and interventions. Those components included: 1) how to sustainably finance the actual non-clinical intervention/activity; and 2) how to fund the trusted convener’s operations in their facilitation of the community-wide population health efforts. In addition, workshop participants wished to learn how each collaborative partner could share in potential savings based on their proportionate investment/role in the interven- tion. In particular, the central issues in this area raised by meeting participants included: Issues Related to Sustainably Financing the Intervention: • How will the intervention be sustainably funded? Community First, Hilo, Hawaii • How can health care sector partners align financing from core Greater Detroit Area Health Council, Detroit, MI operational dollars, community benefit dollars, and premium/ Health Care Improvement Foundation, Philadelphia, PA provider reimbursement dollars? The Health Collaborative, Cincinnati, OH Washington Health Alliance, Seattle, WA • Can/should health care sector partners be held responsible for individuals and activities outside its four walls? 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 • Can/should health care sector partners be held responsible for individuals outside a health care provider’s patient panel or Lessons Learned payer’s enrollees? • Leverage and align existing payment models and measures as • How can the reimbursements for non-clinical interventions a starting point when exploring a population health intervention. flow between health care sector partners and non-health care sector partners? • Identify those payment models that best serve the collective partners needs and capacities. • What level of evidence is sufficient to demonstrate the value proposition of funding the intervention(s)? • Recognize other funding sources may be collectively aligned and used (i.e., funding from multiple sectors; other types of funding from Issues Related to Sustainably Funding Convener: the health care sector like community benefit dollars). • How can the trusted convener’s operational activities be sus- • Explore innovative Medicaid financing changes currently under tainably funded? consideration/development that could support these efforts. • What level of evidence is sufficient to demonstrate the value • Start small, but be sure to use evidence from pilot programs to proposition of funding the trusted convener? provide support and scale up the intervention. It is valuable to: – Identify and prioritize the few population health interventions Key Barriers Identified that do possibly offer positive ROI; • Business Case/Return on Investment (ROI), including: – Use existing data and basic analyses to begin; and –Analyses of promising upstream investments with short-term – Include qualitative data and storytelling to illustrate the value ROI; in reinvestment and rebalancing of funds. –Ability to reconcile up-front investments with longer-term ROI to rationalize the investment; and These five regions will use the information, along with additional –Appreciation of the difference between financial ROI briefs on other topics discussed, and work collaboratively within and social ROI. their communities to apply them to their individual situations. • Accountability that considers the following: –How to differentiate between accountability for providing services to individuals vs. accountability for community-level –The need to explore shared-risk models between heath care population-based outcomes; sector partners and non-health care sector partners. –Which health care sector and/or non-health care sector • Education for all partners to understand: partner(s) should pay/contribute to the service provided; –How alternative payment models function (i.e., how they –How much should be paid/contributed to the service; determine payment for service rendered); and –What processes/outcomes should be measured as part of the –How savings from population health interventions may be intervention’s evaluation; and recaptured in order to support a continuous cycle of reinvest- ment to sustain those interventions. 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.