Healthy Outcomes Initiative Report and Resources

Human services organizations play a vital role in health by addressing the "social determinants of health" – economic stability, education, social connection, housing, safe neighborhoods, and food access. Human Services Organizations: Partnering for Better Community Health explores how collaboration between human services organizations and health systems can help people experience better health outcomes.

The report and comprehensive resources below capture knowledge and insights from the Healthy Outcomes Initiative, a multi-year project supported by The Kresge Foundation, and are intended for those new to human services and health collaborations as well as pioneering practitioners. Click through to explore resources, actionable research, and recommendations for community-based human services organizations to work more effectively with health systems.

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  1. About the Healthy Outcomes Initiative
  2. Why human services organizations are increasingly partnering with health systems
  3. Examples of collaborations
  4. What it takes to partner successfully
  5. How pioneers are institutionalizing collaborative models
  6. Challenges in making collaboration work
  7. NFF's recommendations for how to accelerate this movement
  8. Initiative partners and project descriptions for deep-dive consulting engagements with NFF
  9. Full list of resources

"Seamless coordination between human services and healthcare organizations greatly increases well-being and opportunity for people, especially those with low-incomes. This is why the work of the Healthy Outcomes Initiative is essential for helping the health and human services sectors move beyond collaboration to integration."

David Fukuzawa, Managing Director of The Kresge Foundation’s Health and Human Services Programs


1. About the Healthy Outcomes Initiative

The Healthy Outcomes Initiative (HOI) explored how partnership and integration between community-based human services organizations and health systems can propel large-scale improvements in the health of America’s communities.

In the Initiative, NFF:

  • Built capacity through cohort-based group trainings and intensive, person-to-person consulting with human services organizations embarking on health partnerships, particularly those centering on outcomes. Click here for a complete list of HOI participants, and here for more detail on this work.
  • Developed the Nonprofit Readiness for Health Partnership tool to help human services organizations prepare to engage in partnerships with healthcare organizations
  • Created and shared knowledge on this dynamic issue through briefings with cross-sector stakeholders, conference presentations, and blogs, articles, and case studies, many of which are linked on this page.
  • Fostered cross-sector dialogue through a Learning Network that featured six free virtual panel discussions with leaders in the field.

Learning Network Convenings:

  1. Context and Partnership Landscape (December 2016), with Kristin Giantris of NFF, and Michael Shaw of The Kresge Foundation
  2. Choosing A Partner (March 2017), featuring Project Nightingale partners: Jen Lewis and Jenny Symons of Sonoma County Health Department, and Daniel Schurman of St. Joseph Hospital
  3. Infrastructure, Culture, and Mission Alignment (July 2017), with Paul Castro and Todd Sosna of Jewish Family Services of Los Angeles, and featuring the report Working Together Toward Better Health Outcomes
  4. Key Capacities for Partnership (October 2017), featuring Angela Bovill and Tim Johnstone of Ascentria, and Jeremy Moore of Spectrum Health; NFF also presented two free tools, the Nonprofit Readiness for Health Partnership, and the Partnership Assessment Tool for Health
  5. Partnership and a Pay for Success model (February 2018), with Stephanie Mercier of Corporation for Supportive Housing and Dave Sharar of Chestnut Health Systems on early stage efforts to employ Pay for Success models to improve the health outcomes among homeless populations in McLean County
  6. Addressing Social Determinants of Health (May 2018), featuring Lutheran Social Services of North Dakota and the California Food is Medicine Coalition, both of whom are negotiating contracts with state programs

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2. Why human services organizations are increasingly partnering with health systems

Healthcare in the US is rife with patient dissatisfaction, soaring costs, and poor outcomes, all of which are particularly acute in low-income communities. Amid these challenges, a collective understanding has emerged that housing, employment, economic stability, education, neighborhood safety, nutrition/food security, and social connection shape a person’s well-being far more than medical care alone.

As the experts in addressing these “social determinants of health” and in providing social services in community settings, human services organizations play a critical role in achieving healthy outcomes. Unifying the formerly distinct sectors of human services and healthcare is key to transforming health outcomes in the US.

“A health system that can figure out how to work really collaboratively with community-based organizations will most definitely see improved health status of the people that they serve.”

Jeremy Moore, Director of Community Health Innovations at Spectrum Health

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3. Examples of collaborations

Pioneering human services organizations are working with hospitals, insurers, and government agencies to provide integrated whole-person care. While initially accelerated by the Affordable Care Act, the shift from “volume-based” to “value-based” care varies greatly according to state and local policies and leadership, waivers and pilot programs, and the unique needs of communities. Changing incentives, coupled with poor health outcomes and rising costs, have spurred a wave of partnerships between human services and healthcare organizations to address pressing issues, such as the opioid crisis, homelessness, chronic disease, infant mortality, “super-use” of emergency rooms, recidivism, and others.

A spectrum of integration exists among human services organizations/healthcare partnerships. Sometimes, partners are simply sharing information or making referrals. In deeper partnerships, providers are coordinating their services to serve people more holistically. Some go yet further and share staff, space, and/or resources. At the most integrated end of the continuum, multiple partners are forming new approaches with cohesive programs, planning, and funding.

These projects – like all efforts at greater integration of human services and healthcare – aim to harness data on both outcomes and cost to demonstrate the power of collaborative approaches.

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4. What it takes to partner successfully

For human services organizations:

Investments in capacity and capital are often necessary to support effective partnership, such as:

  • Financial management consulting to assist in mapping the growth and change implications of collaboration to equip leaders to negotiate fair and sustainable contracts.
  • Increased reserves to help human services organizations mitigate risk and weather the ups and downs of exploring new approaches and partnerships in a changing funding environment.
  • Data infrastructure and expertise to measure outcomes and the full cost associated with new approaches and provide the evidence to propel these models into the mainstream.

As part of HOI, NFF developed the Nonprofit Readiness for Health Partnership tool, a free downloadable resource for human services organizations to help identify investments they may need to be ready for partnership.

For healthcare organizations

Partnership also demands operational and cultural shifts on the healthcare side, to allow for joint decision-making and planning (with human services organizations), and to measure and bill for overall health outcomes as opposed to treatments and services. Like human services organizations, healthcare partners often need to bolster their capacity and infrastructure for collection, sharing, and analyzing data. The sharing of data can, in particular, be a new and sometimes uneasy prospect for traditional healthcare, as data has often been regarded as constrained by privacy regulations, proprietary, and a source of competitive advantage.

For both:

Developing a shared language. Human services organizations must articulate their value in dollars as well as mission; and healthcare must shift from seeing human services partners as “do-gooders” to recognizing them as strategic partners that drive improved health.

“To prepare for a partnership, organizations must self-assess to revamp their model. A focus on mission, the mechanics of contracting and billing, administrative and financial burdens, and program delivery models are crucial.”

Alissa Wassung, Director of Policy and Planning (and trailblazing collaborator), God’s Love We Deliver

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5. How pioneers are institutionalizing collaborative models

HOI identified a wave of efforts to institutionalize successful pilots within regular contracting practices and/or expand them into broader arenas to provide stable long-term funding for essential human services. Key to these efforts is in-depth financial modeling to ensure that full costs of growth, change due to new collaborative models of operating, data measurement, and ultimately, service delivery, are incorporated.

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6. Challenges in making collaboration work

Vast differences between human services and health organizations

  • Cultural differences: There is a natural tension between the mission-driven role of human services organizations to address complex socioeconomic barriers and the traditional role of healthcare to address acute medical needs. These diverse orientations have led to differences in priorities, language, and decision-making processes that can inhibit effective partnership.
  • Funding: Human services organizations and healthcare are traditionally funded through very different mechanisms. Healthcare is funded by Medicaid/Medicare and other private insurance, while human services are typically a mix of federal, state, and local government contracts. Braiding and blending funding and changing funding incentives/mechanisms is required.
  • Data: Governments, hospitals, insurers, and managed care organizations hold critical data that is vital for tracking population health outcomes. But access to that data and aligning across sectors is challenging, for both client privacy and competitive reasons.

Given variability across jurisdictions, and uncertainty about future federal, state, and local healthcare policies, human services and healthcare organizations find themselves torn between investing in tomorrow’s promising innovations or continuing to maintain the essential safety net for today. Visionary leaders across the country understand they must somehow continue to do both.

The early activities of collaboration – such as agreeing on governance, navigating service integration, and aligning data systems – are laborious, and the short-term payoff can be hard to measure. Similarly, relationship-building – while vital to success – takes time, and contract reform at the payor level is complex and slow work. For these vital foundational elements of collaboration, funding has been limited.

Uncertain policy environment

Given variability across jurisdictions, and uncertainty about future federal, state, and local healthcare policies, human services, and healthcare organizations find themselves torn between investing in tomorrow’s promising innovations or continuing to maintain the essential safety net for today. Visionary leaders across the country understand they must somehow continue to do both.

Early work of integration is under-funded

The early activities of collaboration – such as agreeing on governance, navigating service integration, and aligning data systems – are laborious, and the short-term payoff can be hard to measure. Similarly, relationship-building – while vital to success – takes time, and contract reform at the payor level is complex and slow work. For these vital foundational elements of collaboration, funding has been limited.

“I don’t think we’ve ever been in a time of more uncertainty in terms of federal resources. We’re worried about the budget, Medicaid, and programs that affect vulnerable people, and we’ve never seen this level of proposed change. There is a real rollercoaster you’re riding as you look at programs and change. You have to be real flexible to see those curves in the road, because they are out there.”

Shirley Dykshoorn, Vice President for Senior and Humanitarian Services, Lutheran Social Services of North Dakota

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7. Recommendations for how to accelerate this movement

Build a pipeline of partnership-ready community-based human services organizations to increase the pace of integration.

Human services organizations are driving forces for improved social, economic, and health outcomes in the US. As the ultimate “doers,” they need to be strong voices in the development of integrative partnerships, and therefore must be equipped with knowledge of the true cost of social change through in-depth financial modeling (for more detail, see page 14 of the report Working Together Toward Better Health Outcomes).

“We need to understand the full cost of meeting outcomes, including things like major investments in backbone support, data systems, and evaluations, all the things various players need to put into place to show outcomes that will reinforce the type of sustainable financing systems we want to put into place.”

Jen Lewis, Special Projects Director at the Sonoma County Department of Health Services, and a leader in the Project Nightingale collaboration

Accelerate the momentum of integration efforts and policy reform through learning and knowledge sharing.

Working in new ways requires continual knowledge-sharing to provide potential partners information about funding arrangements, data and outcomes measures, timelines, cost approaches, contract terms, and service models. Cohorts, cross-sector learning networks, and geographically-focused consortia can amplify the lessons, challenges, and successes of partnership, and unify the many players into a stronger voice for policy reform.

“The challenges of bringing many players to a common table to agree on goals, share data, measure results, institute operating principles, and, ultimately, to fund only what works, are daunting. But continuing with the status quo is not an option. We are losing a generation. We need courageous leadership with new rules for engagement that emphasize true collaboration.”

Melissa Skahan, Vice President of Mission Integration at Mercy Hospital, and Founder of the Greater Portland Addiction Collaborative

Fuel transformation with innovative, flexible capital.

In addition to addressing the persistent underinvestment in community-based human services, funders can invest in changing incentives to accelerate and motivate payors to shift toward collaboration. Finally, funding and financing for data infrastructure and overall improvements in interoperability across different sectors builds the evidence for the wisdom of integrated models.

Conclusion

People in the US have long strived for a society where every child can achieve his or her full potential. Yet in many communities, the obstacles to realizing this vision remain deep and complex, resulting in tragic inequities in opportunity, health, and life outcomes. Today, a deeper understanding of the role of social factors in health outcomes is spurring deeper integration across sectors. NFF believes we must invest in partnerships that address critical preventative social and economic factors like employment, housing, nutritious food, education, and safe neighborhoods. New models of collaboration between healthcare and human services can improve the quality of life for children and families across the country and advance us toward our shared ideals.

“It isn’t just about investors saving money, or hospitals making more, or governments having excess funds – it’s that people get better.”

Mark Ryle, CEO of Project Open Hand

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8. Initiative partners and project descriptions for deep-dive consulting with NFF

HOI Network Organizations and Members

*Denotes organizations that engaged in intensive consulting with NFF.

Project descriptions for deep-dive consulting engagements with NFF

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9. Full list of resources

Tools

Nonprofit Readiness for Health Partnership for human services organizations considering partnership

Partnership Assessment Tool for Health for health and human services organizations in partnership

Insights

On the Broader Context of US Healthcare and Shift Toward Outcomes

On Innovative Financing Models

On Social Determinants of Health

From HOI Clients and Partners

Learning Network Convenings

  1. Context and Partnership Landscape (December 2016), with Kristin Giantris of NFF, and Michael Shaw of The Kresge Foundation
  2. Choosing A Partner (March 2017), featuring Project Nightingale partners: Jen Lewis and Jenny Symons of Sonoma County Health Department, and Daniel Schurman of St. Joseph Hospital
  3. Infrastructure, Culture, and Mission Alignment (July 2017), with Paul Castro and Todd Sosna of Jewish Family Services of Los Angeles, and featuring the report Working Together Toward Better Health Outcomes
  4. Key Capacities for Partnership (October 2017), featuring Angela Bovill and Tim Johnstone of Ascentria, and Jeremy Moore of Spectrum Health; NFF also presented two free tools, the Nonprofit Readiness for Health Partnership, and the Partnership Assessment Tool for Health
  5. Partnership and a Pay for Success model (February 2018), with Stephanie Mercier of Corporation for Supportive Housing and Dave Sharar of Chestnut Health Systems on early stage efforts to employ Pay for Success models to improve the health outcomes among homeless populations in McLean County
  6. Addressing Social Determinants of Health (May 2018), featuring Lutheran Social Services of North Dakota and the California Food is Medicine Coalition, both of whom are negotiating contracts with state programs

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