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August 2016
Policy&Practice
9
improve the customer experience,
within the context of the evolving
health care delivery system. The Triple
Aim and Affordable Care Act continue
to be significant drivers of this trans-
formation. The field at-large, defined
here by all human-serving programs
and networks of care impacting
people’s health and well-being,
continues to reconfigure, test, and
modify how services are paid for and
delivered. Human service agencies,
programs, and providers are also
embarking on this journey to rethink
how to efficiently and effectively
provide existing and new services
within this environment.
H/HS agencies at all levels of govern-
ment and across sectors are building
new connections to better ensure
programs, data, providers, and funding
channels are in place to address the
social determinants of health. State
and local agencies are making impor-
tant advancements to improve their
operational efficiencies and program
effectiveness by using the National
Collaborative’s Business and H/HS
maturity models,
1
in conjunction with
Harvard University’s Health and Human
Services Value Curve,
2
as a common
blueprint and benchmark to implement
these paradigm and operational shifts.
Having a Seat at theTable
is the Just the Beginning
While efforts are being made where
they can, this work is not done. Care
coordination requires equitable invest-
ments in infrastructure, deliberate
analysis of risk-sharing, assessing new
roles and responsibilities of workers, and
rethinking how procurement and dis-
tribution of savings is conducted across
programs and providers. But it must
start with commitment by stakeholders
across health care, human services,
public health, and others to acknowl-
edge each sector’s value in this space
and learn to speak to others in their
language. We need to collectively assess
the full environment of human-serving
programs and creation of upstream
solutions making success attainable for
the people with and to whomwe deliver
services. “Success” may entail getting
the lights on so your children can study
for school or some financial support
to feed yourself or your family if you
have limited means, or getting access to
preventive primary care or behavioral
health services to better manage your
health and reduce the amount of expen-
sive medical treatment later on.
Each human-serving sector has to
make a concerted effort to do things
differently and learn about the other
sectors’ programs, payment mecha-
nisms and financing streams, service
delivery networks, and ultimately, how
to contribute to the solution, so we do
not duplicate or pay for something that
already exists. Health care is evolving
to include new payment and service
delivery reforms and move toward
value-based purchasing for services
by creating incentives to improve
the quality of the services provided.
Some of these efforts are looking at
ways to redistribute or create new
payment mechanisms to reimburse
for services that are typically outside
of the health care system—which may
include existing services provided by
the social- or human-service sector.
Simultaneously, human services are
looking at trauma-informed care and
behavioral economics to inform their
practice models and must connect with
the health system to better identify
the access points and impact on health
outcomes and costs.
These are general steps toward
improved care coordination, but true
partnership and non-duplication of
effort is needed. The health sector has
misconceptions about what human or
social services does and the provider
system it entails. The reverse is also
true: there are misconceptions by
the human or social service sector
about the intricate workings of the
health care sector. The miscommu-
nication and misalignment of both
these existing and transforming care
systems’ efforts to impact the same
thing—the health and well-being
of individuals, families, and com-
munities—exemplifies the deep
disconnection between core elements
and functions of our country’s care
delivery networks.
Human services,
along with their
companion sectors
, are uniquely
positioned to design new initiatives
that can significantly support better
health and stronger individuals,
families, and communities. Human
service resources, along with health
care, public health entities, and
others—already strategically located
throughout communities across the
country—can play a major prevention
role to mitigate serious downstream
health and well-being issues like heart
disease, diabetes, and poverty. All care
systems will need to be educated on
the value and opportunities for true
connections as they move forward.
Research and adequate investments
in human services have also lagged
behind that of health over the past
decade. This has made it extremely
difficult to study, measure, and scale
evidence-based social interventions.
In the evolving context of value-
based payment on the health care
side, this lack of information adds
another level of complexity. The
value
of human services is real but diffi-
cult to measure and, many times, is
measured differently than quantifi-
able health outcomes. How do we
know where savings on reductions
in health care costs and improved
outcomes are attributable to specific
social interventions? This question is
valid, yet we cannot lose sight of the
historical presence of human services
in communities, the deeply embedded
trust citizens have for them, services
provided beyond eligibility and
referrals, and the very real political,
under-funded, and highly regulated
environment in which these human
service programs operate.
See National Collaborative on page 46
Improved outcomes,
lower costs, and a
healthier society as a
whole will be the tangible
results of these efforts
through effectively
linking and supporting
integration of operations,
funding, design, and
delivery of care.
Illustration via Shutterstock