The Better Care Playbook’s Post

Completely agree - want to learn how VBC can impact equity? Attend our VBC webinar (priced for equity!) https://lnkd.in/enkdTUAk It’s coming up soon!!

Here we go health system and policy classes!

How Payers and ACOs Can Contract More Efficiently with Social Services Providers As the Total Cost of Care continues to climb, even under value-based payment models, the increasing prevalence of Health-Related Social Needs (HRSNs) among patients and members is prompting an essential shift in healthcare strategy — embracing a more integrated approach with social service providers, including Community-Based Organizations, Community Care Hubs, and Area Agencies on Aging. Current research underscores that clinical care influences only about 20% of the variations in health outcomes, while social determinants of health (SDOH) impact up to 80%. This significant influence demonstrates the necessity for ACOs and payers to forge robust networks with social service providers who are uniquely positioned to address these social needs. Establishing sustainable contracts and revenue streams for these providers, payers, and ACOs can significantly enhance care quality, patient or member comfort, and cost efficiency. A Strategic Approach to Combined Risk (Social Clinical.)  To manage the rising costs effectively, ACOs and payers must assess their populations' Combined Risk (Clinical Social). This assessment isn't just a numeric evaluation—it's about understanding the connection between medical and social factors that influence health outcomes. We’ve taken steps to facilitate this by matching population and member HRSNs with networks for social providers in a region. It’s one of the first steps in ensuring patients receive the whole-person care they need to improve health outcomes. Moving ACO, Payer, and Community Care Hub Relationships from Transactional to Transformational.  The transition from transactional relationships to transformational partnerships is critical. ACOs and payers need to align incentives and contract terms with upstream HRSN social service providers to recognize and reward the significant impact these providers have on downstream healthcare costs and utilization. This alignment is crucial for developing contracts that address immediate healthcare needs and foster long-term sustainability and health equity. This can equip ACOs and payers with the capabilities to plan, perform, and sustain effective value-based care models that consider their social service providers. These tools help identify patients and members who require the most intensive care and connect them with the appropriate healthcare and social services providers. The journey towards efficient, value-based healthcare requires a fundamental shift in how we perceive and manage health and social care. By harnessing the power of combined clinical and social risk assessments, we can create a more sustainable, equitable, and effective healthcare system. Leave a comment to learn more about this transformative approach, or see it in action. #HealthcareInnovation #ACOs #SocialDeterminantsOfHealth #ValueBasedCare #HealthRelatedSocialNeeds

How successful are you at getting members who are at-risk for health equity to accept assessment appointments? Often this cohort of your membership has never engaged with you. It keeps care management from being engaged with their population health tactics to aid these vulnerable populations. We know that a key segment of membership is alienated by language, cultural, and financial barriers. There is a lack of understanding on the part of the membership of what resources and valuable assistance is available due to a lack of trust in the system trying to help them. You simply cannot reach them on your own terms because you do not have a trusting relationshipthat would enable them to let you into their worlds. Harmony Health provides a way to build the trust bridge by flipping the paradigm about how, when and where your plan can effectively engage with and activate these difficult population cohorts. That is what they do: build bridges that bring people across to you and allows you in to impact their lives in a positive way.  The trust resides in the grassroots community based organizations (CBOs):  churches, food pantries, homeless shelters, Habitat for Humanity, FQHCs, and so on.  Harmony Health develops partnerships with these CBOs by giving them free text messaging tools to use to support their missions.  Harmony Health enables the CBOs to amplify the trust with these simple tools to boost their relationships with the at-risk populations.  Their government and health plan partners piggy-back on the stream of messages going out to these beneficiaries. Harmony Health has been hired by the California State Department of Health Services to break this impasse on their behalf by campaigning successfully in messaging over 1.5 million low income and at-risk cultural segments to get them into care plans and to recertify their Medicaid eligibility, for example. Several Managed Care Organizations likewise have tapped Harmony Health to do the same for them. And these contracts keep getting renewed and expanded as greater results accrue, justifying the increase in the outreach scope and scale. Near Los Angeles, they serve a monolingual Chinese population where Harmony Health conducted 68 outreach programs in 2023 including prevention and management of colorectal and breast cancer, diabetes, substance abuse, positive parenting and trauma support with strong results. The opt-out rates range from as low as .5% to as high as 1.5%, depending on audience but average around .85%! I am happy to introduce Harmony Health.

Health-related social needs such as food, shelter and transportation are an increasingly important and incentivized area of health care. Learn about the Accountable Health Communities Model from Centers for Medicare & Medicaid Services and how it supports universal #HRSN screening.

A recent AJMC - The American Journal of Managed Care article spotlighted the findings from the 2024 State Health Disparities Report by The Commonwealth Fund emphasizing the persistent lack of equitable access to care among the nation’s most vulnerable populations, including those enrolled in #Medicare, #Medicaid, and #DSNP.    Addressing these glaring health equity disparities demands a comprehensive, ongoing #memberintervention and outreach strategy that transcends conventional “engagement” efforts by #healthplans. It entails actively connecting with members to foster trust, identify their disparities, and commit to overcoming each obstacle.    Achieving #healthequity necessitates prioritizing member-first engagement to demonstrate unequivocally that their health plan advocates for them and is dedicated to enhancing the quality of their healthcare.    https://lnkd.in/esdJgCSG  

This is a good introduction to an emerging opportunity to reduce total costs and support individuals. It describes an endpoint that could be win for Community Organizations and the Patients they serve, as well as upstream committed healthcare providers and payers. It also outlines a direct and simple (accountable) way to deal with the need to address HRSNs and build a sustainable model based on the redistribution of small parts of existing healthcare resources based on proven results and ROI. A portion of the savings from reducing healthcare utilization would go a long way to supporting Community Based support services - it is highly leverage-able. The Nascate team is currently working on this opportunity. Creating the required insights to size up the opportunity before you begin, set expectations and contract requirements with payers. Then, with those insights in place you can begin to focus on performance and a virtuous cycle of growth funded by proven savings. The "Social" part of this seems to me to be attractive because it reduces the barriers to entry and staffing. I believe that if focused on the right population, curated with the right existing community providers, supplemented (rather than replaced or overwritten) by addressing missing capabilities, the model can be made to work and be cost effective. Perhaps most importantly, it can be affordable and it can be fast to get it up and running. Results and ROI being the driving KPIs. What are your thoughts on this idea "Social ACO" ... is it on target or too far ahead of the curve? Is the healthcare industrial complex ready for such a solution - even if it is just a small part of the overall portfolio of improvement ideas?

Community health workers (CHWs) are essential to bridging gaps between providers and patients in health care delivery. During the COVID-19 pandemic, CHWs helped improve vaccination rates and access to care in medically underserved communities. A new literature review utilizes RADx-UP data to identify barriers to utilizing CHW care models in health care transformation. The recommendations to policymakers, payers, and providers include: • Expanding billing codes • Developing equitable compensation • Incorporating CHW contributions in quality metrics • Utilizing existing competency models for training Learn more: https://bit.ly/3vyRdxk #RADxUP

This Thursday, Dr. Brandon G. Wilson, DrPH, MHA, Senior Director for the Center for Community Engagement at Community Catalyst, will lend his expertise to a Health Affairs panel to discuss how we can improve care for people who are dually eligible for Medicaid and Medicare. Learn more & register for the panel here: https://commcat.io/46ChU1V    Want to learn more about how health care advocates and stakeholders can center the needs of dually eligible people?     ✅ Read Dr. Wilson’s recent article for Health Affairs on why we need to ask dually eligible people: what do they want? >> https://commcat.io/41XgkEz    ✅ Explore our report examining the prospect of a federal resource hub as a way to address the information and resource gaps that dually-eligible people experience. >> https://lnkd.in/e9NSsRCn