APHSA Annual Report 2018

The Value Curve lies at the foundation of the ISBM’s aims to increase the ability of the H/HS system to collaborate internally and with community partners with a patient-centered lens, but also seeks to address critical social determinants of health through multigenerational interventions to help move individuals, APHSA was exceptionally well positioned to assist in the collaboration between the state of MN and localities due to our background of working with counties and the state of MN in past projects. Facilitating in a manner that helped lead to role clarity and mutual collaboration was especially crucial for the success of the ISBM moving forward within their state-supervised, county- administered human services structure. Since completion of the integration institute, the ISBM model has received agreement in principle from the MN counties through the Minnesota Association of County Social Service Administrators (MACSSA). The ISBM now at the heart of DHS’ long-term strategic plan and DHS and its partners have started a multi-year implementation plan for the ISBM. As MN takes steps toward jointly developing an innovative vision, infrastructure and capacity to achieve the vision, this partnership is positioning itself on a path toward macro-level impact across the state. families and communities toward sustainable health and well-being.

barriers that get in the way of FSSA’s members being as healthy as they can be. To achieve these goals, FSSA began partnering with state agencies that provide services impacting one or more of the socio-economic or environmental factors impacting their members, including the Indiana State Department of Health (ISDH), Department of Transportation, Housing and Community Development Authority and Workforce Development. Also, the team partnered with Indiana University and members of the Indiana Health Information Exchanges, as well as several providers, managed care entities and a multitude of community-based organizations. The goal is to better understand and identify opportunities to proactively address several factors, including conditions in which people are born, grow, live, work and age. Since kick-off, several teams have been formed and are making notable progress. Each team is focused on a core workstream and will serve as the foundation needed to build the remaining components of the program. The first team consists of sixteen volunteers from across FSSA and ISDH, and it is focused on lifting what is currently known about the social determinants of health and how best to create awareness and understanding going forward. The second team has already developed and deployed an assessment tool consisting of a set of ten optional questions that will collect information about socio-economic and environmental factors as well as health behaviors. In August 2018, it was added to all new Medicaid, SNAP, and TANF applications. The third work stream underway is the development of a state-wide community-based services network to help understand what services exist, determine where there are gaps and ultimately enable FSSA to make referrals. Examples of these services include food pantries, transportation and access to safe and affordable housing.

STATE OF INDIANA Earlier this year, the Secretary of IN Family and Social Services Administration (FSSA) , Dr. Jennifer

Walthall, announced the formation of a new division to focus on health equity. One of the key focus areas is addressing the social determinants of health. This initiative, called “Healthy Opportunities,” is dedicated to ensuring Hoosiers have equitable access to social and physical supports needed to promote health from birth through end- of-life, and helping remove or reduce any


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