These case studies are part of an effort to better understand current practices regarding non-medical, upstream population health investments that can be responsive to performance-based and other healthcare payment reform strategies. Sites have hospital or health system investments underway that are targeted, evidence-based, collaborative with community partners, and have generated or modeled health improvements and cost savings that are or may be linked to performance-based contracting. The four sites include:
Burlington, Vermont: The University of Vermont Medical Center has had a multi-year supported housing collaboration with a local low-income housing provider that has demonstrated health status improvements and reduced hospital-related costs. The third collaborative site opened last month. This site visit is particularly interesting due to the role the state-legislated healthcare cost control authority, the Green Mountain Care Board, played in facilitating upstream non-clinical investments of net patient revenue when a hospital exceeds established budget caps.
Muskegon, Michigan: Mercy Health Muskegon, and its subsidiary, the Health Project, through an AHRQ-certified community health worker (CHW) intervention, Pathways, demonstrated savings and health status improvements during a Center for Medicare and Medicaid Innovation (CMMI) demonstration and has since been fully funded by the hospital’s community benefit structure. Prior development of this strategy by the Health Project with multiple at-risk populations laid the foundation for their success. The hospital system has been in discussion with payers about reimbursing for the service and is working on component pricing. Among the interesting aspects of their approach is the effective use of purchased and embedded CHW support with collaborating community social service agencies focused on various social determinants of health.
Cincinnati, Ohio: A multi-partner cross-sector collaboration is underway to improve pregnancy outcomes in Cincinnati where low birth weight and high infant mortality have been ongoing concerns. Coordinating strategies in a city with multiple hospital systems has been challenging over time. Interventions include cross-hospital coordination, prenatal clinical management improvement, and strategies to address social determinants of pregnant women’s health, including a Medicaid-funded community health worker initiative. Learning collaboratives and targeted data analytics are supporting the movement forward. Among other unique resources in Cincinnati is the Health Collaborative which originated as one of the most successful health information exchanges and, in its current structure, continues to provide important data management and analytic functions and as a convener of the six hospital systems in the area and other public and private health entities.
Greenville, South Carolina: Greenville Health Systems (GHS) addresses the social determinants of health of their chronically ill, uninsured populations through an innovative neighborhood medical home strategy. Community Paramedicine and other efforts that are part of their Accountable Communities Initiative sit on a unique platform of incentivized medical care delivery and coordination provided through a major state Medicaid initiative, the Healthy Outcomes Plan, and philanthropic resources. GHS is seeking to build an “ACO for the uninsured” that focuses on addressing social determinants of people’s health by wrapping non-medical supports around free and subsidized care.