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Braiding and Blending of Funding

National Academy for State Health Policy -NASHP, “Blending, Braiding & Block-Granting Funding for Public Health and Prevention: Implications for States.”

  • Issue brief developed in collaboration with the de Beaumont Foundation and the Association of State and Territorial Health Officials, which provides analysis and recommendations for states interested in coordinating services and resources across programs.

NASHP, “Braiding the Blending Funding Streams to Meet the Health-Related Social Needs of Low-Income Persons: Considerations for State Health Policymakers.”

  • Issue brief highlights non-Medicaid funding sources that states could leverage through braiding or blending to better address social determinants or other needs that are not typically addressed by Medicaid.

Center for Health Care Strategies, “State Payment and Financing Models to Promote Health and Social Services Integration.”

  • Issue brief reviews several financing mechanisms for states considering greater health and human service integration, with a focus on Medicaid. Suggested models described range from one-time seed funding to broader braiding and blending strategies. The brief also summarizes ways that states can better encourage providers to incorporate social services into their care.

Integrating Services and Benefits

Milbank Memorial Fund, “Medicaid Coverage of Social Interventions: A Road Map for States.”

  • Issue brief developed in coordination with the Reforming States Group and the New York State Health Foundation, which provides a guide for states in understanding how to leverage current Medicaid flexibility to facilitate access to social services.

Commonwealth Fund, “A State Policy Framework for Integrating Health and Social Services.”

  • Issue brief describes three components that states must implement in order to integrate health and social services: a coordinating mechanism, appropriate quality measurement and data-sharing tools, and aligned financing and payment procedures.

Commonwealth Fund, “Investing in Social Services as a Core Strategy for Healthcare Organizations: Developing the Business Case.”

  • Issue brief describes examples of private sector investments in social determinants of health as a key part of healthcare business operations.

 Commonwealth Fund, “Addressing the Social Determinants of Health through Medicaid Managed Care.”

Report describes current flexibilities for states to leverage Medicaid managed care to incorporate social determinants into their Medicaid programs.

Center for Health Care Strategies, “Supporting Social Service Delivery through Medicaid Accountable Care Organizations: Early State Efforts.”

  • Issue brief describes how state Medicaid programs have incorporated social services into Medicaid accountable care organization models.

Health Affairs, “Integrating Medical and Social Services: A Pressing Priority for Health Systems and Peers.”

  • Blog post lists a number of studies related to social determinants, including efforts to better study and understand the role that social determinants play in health outcomes.

Center for Health Care Strategies, “Measuring Social Determinants of Health among Medicaid Beneficiaries: Early State Lessons.”

  • Issue brief describes state efforts to collect and use data on social determinants to drive program improvements and strengthen the linkages between health and social service agencies.

JAMA Forum, “State Flexibility for Medicaid: How Much?”

  • Blog post notes that state flexibility has been integral to Medicaid, and calls for greater flexibility in using Medicaid and other healthcare funds to invest in the social determinants of health.

Medicaid and Housing Integration

NASHP, “Federal and State Collaboration to Improve Health through Housing.”

  • Issue brief provides policy recommendations to align health and housing programs to ensure that beneficiaries receive needed housing and supportive services.

NASHP, “Improving Health through Housing: Three Tips for State Policymakers.”

  • Blog post provides three concise recommendations for states to consider that would help to improve health through housing.

Kaiser Family Foundation, “Linking Medicaid and Supportive Housing: Opportunities and On-the-ground Examples.”

  • Issue brief outlines currently flexibilities in the Medicaid program to support supportive housing services, and highlights three initiatives that target special populations including homeless individuals, people with disabilities, and adults with mental health and/or substance misuse disorders.

Center for Health Care Strategies, “Medicaid-Financed Services in Supportive Housing for High-Need Homeless Beneficiaries: The Business Case.”

  • Issue brief describes why states should consider designing Medicaid-financed, supportive housing-based care management services.

Brookings Institution, “Re-balancing Medical and Social Spending to Promote Health: Increasing State Flexibility to Improve Health through Housing.”

  • Issue brief describes some of the evidence supporting initiatives to link healthcare and housing services as well as current federal programs that engage housing to help address health.

Center on Budget and Policy Priorities, “Supportive Housing Helps Vulnerable People Live and Thrive in the Community.”

  • Issue brief describes the importance of supportive housing services, in combination with affordable housing to help vulnerable individuals maintain independence and improve health.

Brookings Institution, “Housing as a Hub for Health, Community Services, and Upward Mobility.”

  • Report describes the way in which housing can impact social determinants, and current efforts and barriers to improving access to affordable, healthy housing for low income Americans. It additionally makes several recommendations, including to improve data collection and use, to improve budget and funding coordination, to allow for experimentation in models, and to strengthen housing and healthcare partnerships.

Data and Systems Integration

Center for Health Care Strategies, “Screening for Social Determinants of Health in Populations with Complex Needs: Implementation Considerations.” 

Issue brief reviews key considerations for organizations to consider when seeking to collect and use data on social determinants to improve patient care.

National Quality Forum, “Food Insecurity and Housing Instability Final Report.” 

Report provides a framework for state Medicaid programs to use in collecting and using data on social determinants of health in order to address social needs.

HHS Assistant Secretary for Planning and Evaluation, “Status of State Efforts to Integrate Health and Human Services Systems and Data: 2016.”

  • Report finds that in response to federal policy and new funding opportunities aimed at improving efficiency and effectiveness, states worked to strengthen connections between their health and human service programs through increased interoperability and systems integration. About two-thirds of states have integrated eligibility and enrollment systems shared by Medicaid and at least one human service program. Further, the report finds that data sharing across programs is common in most states but often only among programs in the same department or agency.

National Governors Association (NGA), “Improving Human Services Programs and Outcomes through Shared Data.”

  • NGA convened a small group of state and local agency leaders, researchers and other experts to discussed the ways “in which shared data can enhance the effectiveness and efficiency of public programs – for example, by reducing the time and burden of separate intake and enrollment systems; helping agencies better understand client needs, develop appropriate solutions and document outcomes and facilitating research that can inform policy decisions.”

NGA, “Using Data to Better Serve the Most Complex Patients: Highlights from NGA’s Intensive Work with Seven States.”

  • Issue brief notes that “among the most critical elements in providing better care for [complex care patients] are data. Before state leaders can begin to address their super-utilizer populations, they first need to understand who those patients are, how they use the health care system, and how the state might adapt its system to meet patient needs.”

Deloitte Center for HealthSolutions, “Social Determinants of Health: How are Hospitals and Health Systems Investing in and Addressing Social Needs?”

  • A survey of 300 hospitals and health systems finds that providers are investing in health-related social needs, and that “80 percent of hospital respondents reported that leadership is committed to establishing and developing processes to systematically address social needs as part of clinical care.” Hospitals are increasingly screening patients and performing interventions, which may be spurred on through the shift towards value-based care.