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CommUnity Advocacy Connecting Managed Care with Public Health 2014 Pamme Lyons-Taylor Vice President Advocacy & Community Based Programs. Health Factors and Health Outcomes. The 80/20 Rule.
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CommUnity AdvocacyConnecting Managed Care with Public Health 2014Pamme Lyons-TaylorVice President Advocacy & Community Based Programs
Health Factors and Health Outcomes The 80/20 Rule County Health Rankings show that much of what affects health occurs outside of the doctor’s office. Physicians surveyed say: Unmet social needs are directly leading to worse health. The problems created by unmet social needs are problems for everyone. Robert Wood Johnson Foundation
How Social Supports Link with Managed Care Community based services include those programs that address social barriers to accessing healthcare like utility assistance, nutrition and so on. These have not historically been included in benefit packages. Community Based Programs
How Social Supports Link with Managed Care Community based services include those programs that address social barriers to accessing healthcare like utility assistance, nutrition and so on. These have not historically been included in benefit packages. Community Based Programs Contracted Social Supports Contracted community based supports vary based on population and coverage program and are included in benefit packages like Long Term Social Supports (or LTSS). These usually include services like in-home respite.
How Social Supports Link with Managed Care Community based services include those programs that address social barriers to accessing healthcare like utility assistance, nutrition and so on. These have not historically been included in benefit packages. Community Based Programs Contracted Social Supports Contracted Acute Care / Preventive Care Services Contracted community based supports vary based on population and coverage program and are included in benefit packages like Long Term Social Supports (or LTSS). These usually include services like in-home respite. Acute care services comprise the remaining contracted benefits and some enhancements. These are typically included in HEDIS and quality measures.
Social Supports are not “one-size-fits-all” Temporary Assistance for Needy Families Community Based Programs
Social Supports are not “one-size-fits-all” Temporary Assistance for Needy Families Low Income Aged, Blind and Disabled Community Based Programs
Social Supports are not “one-size-fits-all” Temporary Assistance for Needy Families Low Income Aged, Blind and Disabled Community Based Programs Long-Term Care
Social Supports are not “one-size-fits-all” Temporary Assistance for Needy Families Low Income Aged, Blind and Disabled Community Based Programs Long-Term Care Aged and Retired
Social Supports are not “one-size-fits-all” Temporary Assistance for Needy Families Low Income Aged, Blind and Disabled Community Based Programs Long-Term Care Aged and Retired Dually Eligible
Social Supports are not “one-size-fits-all” Temporary Assistance for Needy Families Low Income Aged, Blind and Disabled Community Based Programs Long-Term Care Aged and Retired Dually Eligible Special Populations
Social Supports are not “one-size-fits-all” Temporary Assistance for Needy Families Community Based Programs Aged and Retired
Risks to Funding, Recovery & Philanthropy Recovery Philanthropy Four years of budgetary surplus (2004-2007) resulted in $936B in accumulated cash that was virtually wiped out in two years of recession. Recovery spans tens years. Giving in the US stabilized at $45.7 billion in 2010, following a record 2.1% decline in giving (2008 – 2009) and an unprecedented 17% drop in foundation assets in 2008 Source: Center for Budget and Policy Priorities, April 2012 Source: The Foundation Center, Foundation Yearbook, April 2011
CommUnity Advocacy Model Overview Process / Tools Outcomes / Results Research / Design CommUnity Command CenterCatalogue of Social Supports Community ActivitiesCommunity Health Planning / ResearchWorkforce Innovation / Diversity Strategic Giving Improved Health Outcomes Automated Analytics Management Reports Cost Containment Intra-agency Collaboration Growth / Expansion Quality / HS Analytics Field-based Community-focusedResources Liaisons / Advocates Community Investment Fund HealthConnections Councils Evaluation