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Social Services Paid by Health Plans?

By Monica E. Oss

It’s funny what eliminating silos in health care spending will do. The Patient Protection and Affordable Care Act (PPACA) ushered in an era of health care spending that prohibited preexisting condition clauses, eliminated annual and lifetime limits, institutionalized parity for behavioral health conditions in more coverage, brought population health to hospital systems via accountable care organizations (ACOs), and created a path to reducing the number of Americans without insurance. And, suddenly, we have more attention to the social determinants of health and the importance of funding social services to reduce health care costs (see Social Determinants of Health & Medical Homes).

But there has been more talk than action on this issue. With health homes we’ve seen some movement for health care organizations to coordinate with social service agencies – both health homes (see How Are Medicaid Health Homes Reimbursed for Services?) and ACOs are doing more to coordinate consumers’ social service needs (see What Are The Different Medicaid Performance & Reimbursement Models For ACOs?: An OPEN MINDS Market Intelligence Report). And some health insuring organizations are giving grants to social service agencies to support social services (see The Health Care/Social Service Seesaw and Making The Connection Between Health Care Costs & Social Support Services).

But payment by health plans for social services has been off the table with “medical necessity and clinical appropriateness” as the fundamental definition of what to pay for. A couple years ago, we had several states try (and fail) to get CMS to pay for housing (see Is Housing Health Care? and Health Care Spending vs. Social Service Spending).

But are we seeing a crack in the wall between health care and social services? You might think so if you listened to former Oregon Governor John Kitzhaber’s recent speech on September 29 at the annual State of Reform conference in Portland. Governor Kitzhaber called for a shift in Oregon Medicaid’s waiver spending to focus more on social support service. The proposal he supports calls for earmarking 5% of the state’s Coordinated Care Organization (CCO) spending for social services, with the percent of spending on social services gradually increasing to 25% over time (see Kitzhaber Returns from Exile to Target Social Determinants of Health). This plan and others like it may or may not be adopted, but it points to a trend we’re seeing across the country — states, managed care organizations (MCOs), and provider organizations are coming to recognize the importance of social determinants of health.

An early proponent of addressing the social determinants of health has been Arthur C. Evans Jr., Ph.D., commissioner of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). In his keynote address at The 2015 OPEN MINDS Performance Management Institute (see Tending to the Social Determinants of Health – or Not) he spoke of Philadelphia’s approach to addressing social determinants of health and their success.

Dr. Evans recently noted that the Philadelphia DBHIDS “literally saved millions of dollars” through reinvesting in a broad range of services and programs that address social determinants of health, like homelessness and housing. Moreover, the savings generated allowed the organization to increase its investment in population health strategies, like Mental Health First Aid training — and deliver it free of charge to people who live, work and study in the city of Philadelphia. He said:

It’s much more cost-effective, we have better outcomes, and we get people off the street. It’s a win-win-win for us, because we’ve gotten efficiencies through addressing social determinants of health, resources were freed up that otherwise would have historically gone into treatment.

Traditionally, mental health systems have only focused on people once they have a diagnosis. The problem with that is we spend little of our resources intervening earlier. For the person who’s experienced a traumatic event, there’s literally no intervention until the person develops PTSD, and then they can be treated. Too often, those are things we don’t pay attention to in health care. We spend a lot of time thinking about biology, genetics, and viruses, but we don’t think as much about stress, poverty, or any other social or economic factors that influence our health.

The more of those events you have in early life, the more likely it is you’ll have health problems like diabetes, cardiovascular disease and those kinds of conditions, but also mental health disorders and social problems like homelessness. This is probably some of the clearest evidence that what’s happening in our social environment can have a direct impact on our health later on in life. What we’re saying is that we ought to be going upstream to lessen the likelihood that someone is going to develop a mental health and/or a substance use challenge, and educate people so they’re seeking out and getting help at an earlier point in time.

For more on how payers and health plans are addressing social determinants of health – like access to housing, nutrition, and adequate social supports – check out these OPEN MINDS resources: What Services Are Available For Nutrition Assistance & What Is U.S. Spending On Those Programs?: An OPEN MINDSMarket Intelligence Report and What Income Assistance Is Available To Consumers Through TANF & How Does It Vary By State?: An OPEN MINDS Market Intelligence Report.

And to get an update on Philadelphia’s cutting-edge program for addressing health with an integrated approach to social determinants, don’t miss Dr. Evans in Understanding the Role of Social Determinants in Population Health Management, a free PsychU virtual forum on November 17 at 12:00 p.m. EST. You can also follow Dr. Evans on Twitter @ArthurCEvans.

Population Heath: Creating Communities of Wellness Part II

Dr. Fabius returns to share additional thoughts on the definition and management of populations.  He will provide a recap of what he covered previously with us in June as well as explore key components of population health.  He will again feature highlights from his textbook POPULATION HEALTH: Creating Cultures of Wellness.  Dr. Fabius will speak to the important role behavioral health plays and why implementing population health is crucial as the health care delivery system transitions for rewarding volume to value.  He will close with some of his latest research on what comes after population health – building cultures of health and wellness.  By applying these teachings it may be possible to make Philadelphia the healthiest city in the country.   

Population Health: Creating Communities of Wellness Part II

Dr. Ray Fabius returns to share additional thoughts on the definition and management of populations.  He will provide a recap of what he covered previously with us in June as well as explore key components of population health.  He will again feature highlights from his textbook POPULATION HEALTH: Creating Cultures of Wellness.

Dr. Fabius will speak to the important role behavioral health plays and why implementing population health is crucial as the health care delivery system transitions for rewarding volume to value.  He will close with some of his latest research on what comes after population health – building cultures of health and wellness.  By applying these teachings it may be possible to make Philadelphia the healthiest city in the country.

Population Health: Providing Early Intervention and Prevention

Please join us as Dr. Rose Julius leads the next Population Health conversation. This week’s roundtable will focus on providing early intervention and prevention. There will always be a need for access to high-quality clinical care, supports, and services. A population health approach provides such care and also works to screen for and prevent the onset or progression of conditions, which improves outcomes and better utilizes resources.

Population Health: Promoting Health, Wellness & Self-Determination

Please join us on Wednesday July 27 as Dr. Geoff Neimark, M.D., Chief Medical Officer of CBH leads the next Population Health conversation. This week’s roundtable will focus on promoting health, wellness, and self-determination. Health is much more than the absence of illness or management of symptoms. There is a fundamental difference between providing targeted interventions to address illness versus promoting wellness and quality of life.

Kicking Off Population Health: Promoting Health, Wellness, and Self-Determination

DBHIDS invites you to learn about an innovative approach the Department is taking improve the health of everyone on our communities. This approach, called population health, helps to create communities in which ever member — not just those who seek out services — can thrive. A population health approach seeks to promote healthy and wellness in all, not just to diagnose and address the challenges of some.

We believe there are two compelling reasons for Philadelphia to adopt a population health model:

  1. It is a natural continuation of the important work the we’ve done to transform our system of care, and
  2. It is where the U.S. health care environment is already moving towards to further help contain costs and achieve better health outcomes.

We know that addressing not only the medical but also the social, environmental, and political determinants of health will support the health and well-being of all and bring us closer to eradicating health inequalities in and across our communities.

To ground, educate and excite community members, providers, stakeholders and others about population health and the implications of it, the Department will be hosting a variety of upcoming educational meetings focused on population health starting in June throughout August.

Additionally, below are other population health-focused meetings that we encourage you to attend this summer:

Kicking Off Population Health: Attending to the Whole Population

DBHIDS invites you to learn about an innovative approach the Department is taking improve the health of everyone on our communities. This approach, called population health, helps to create communities in which ever member — not just those who seek out services — can thrive. A population health approach seeks to promote healthy and wellness in all, not just to diagnose and address the challenges of some.

We believe there are two compelling reasons for Philadelphia to adopt a population health model:

  1. It is a natural continuation of the important work the we’ve done to transform our system of care, and
  2. It is where the U.S. health care environment is already moving towards to further help contain costs and achieve better health outcomes.

We know that addressing not only the medical but also the social, environmental, and political determinants of health will support the health and well-being of all and bring us closer to eradicating health inequalities in and across our communities.

To ground, educate and excite community members, providers, stakeholders and others about population health and the implications of it, the Department will be hosting a variety of upcoming educational meetings focused on population health starting in June throughout August.

Additionally, below are other population health-focused meetings that we encourage you to attend this summer:

Kicking Off Population Health: Creating Communities Wellness

DBHIDS invites you to learn about an innovative approach the Department is taking improve the health of everyone on our communities. This approach, called population health, helps to create communities in which ever member — not just those who seek out services — can thrive. A population health approach seeks to promote healthy and wellness in all, not just to diagnose and address the challenges of some.

We believe there are two compelling reasons for Philadelphia to adopt a population health model:

  1. It is a natural continuation of the important work the we’ve done to transform our system of care, and
  2. It is where the U.S. health care environment is already moving towards to further help contain costs and achieve better health outcomes.

We know that addressing not only the medical but also the social, environmental, and political determinants of health will support the health and well-being of all and bring us closer to eradicating health inequalities in and across our communities.

To ground, educate and excite community members, providers, stakeholders and others about population health and the implications of it, the Department will be hosting a variety of upcoming educational meetings focused on population health starting in June throughout August.

Please join us for the first kick-off meeting on June 15th from 12:00 p.m. to 1:30 p.m. held at 801 Market Street (11th floor conference room) featuring international leader Dr. Ray Fabius MD, CPE, FACPE Co-founder and President of HealthNEXT. Dr. Fabius is world renowned scholar and leader in crafting the population health approach and building organizational wellness. Dr. Fabius, he is a faculty member of the American College of Occupational and Environmental Medicine, the new School of Population Health at Thomas Jefferson University, and the American Association of Physician Leadership, where he is recognized as a Distinguished Fellow. He is the author of four books on medical management and population health – the latest one is a graduate school textbook titled Population Health: Creating a Culture of Wellness).

Additionally, below are other population health-focused meetings that we encourage you to attend this summer:

Population Health

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What Is Population Health?

Population health refers to the health of a community. Traditional approaches to health care center around individuals who are already experiencing a health-related condition. Population health approaches take a much broader view, seeking to improve the health status of everyone in a community, not just those who are sick. By providing excellent clinical care as well as community-level interventions and services, population health approaches help to create communities in which every member — not just those who seek out health services — can thrive.

Learn more about DBHIDS’ population health approach.

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