P&P August 2016

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 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.

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.

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

See National Collaborative on page 46

Illustration via Shutterstock

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August 2016   Policy&Practice