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Moving from “sick care” to “health care”

We know that an ounce of prevention is worth a pound of cure. So why do we still expend so much effort treating people after they get sick, and so little addressing the conditions that make them sick in the first place? How do we move from a sick care system to a health care system?

Prevention is the key, but prevention doesn’t just mean check-ups and vaccines. Health care providers and policy makers increasingly recognize that the social determinants of health—including income, education, and housing conditions—often have a greater impact on health outcomes than does health care. And leadership at hospitals and health systems see the value in it too– according to recent Deloitte research , 80 percent of their leadership is committed to addressing the social determinants of health.

Barriers to addressing the social determinants of health

Moving from sick care to health care would require a fundamental shift in the way state and local governments and other community partners interact. Instead of operating in silos that create structural and cultural barriers to care, medical and community services should work together to coordinate care and services for the most vulnerable people in our population. This could be challenging for a number of reasons:

  • Nationwide, there is inadequate leadership capacity and a lack of sustainable funding mechanisms for health improvement efforts.
  • Current funding processes often fragment the distribution of resources, discourage the coordination of funds, and can limit the ability to jointly address common risk and protective factors.
  • Health care, public health, social services, and other sectors typically function and are funded in silos, with different funding requirements and often-incompatible data collection and information systems. This can make it difficult to coordinate efforts, integrate data, and assess shared impact across sectors.
  • Although investments in one sector can affect outcomes and generate cost savings in another, individual sectors generally consider only their own investments and benefits—“the wrong pocket problem.”
  • The multiple sectors that affect health—often driven by a variety of stakeholder and interest groups—have different cultures, values, and vocabularies and generally lack experience working together. This can impede partnership and collaboration.

In Supporting Healthy Communities, we explore a possible solution: the Healthy Communities Funding Hub model, a place-based “hub” where many of these barriers can be addressed.

The Healthy Communities Funding Hub model

Monitor Deloitte worked with the non-profit Trust for America’s Health (TFAH) to further explore and define a funding model previously developed by TFAH. Throughout the summer of 2016, the two worked together to conduct a series of expert interviews and workshops with key players and thought leaders in the field, to vet and further develop the concept. The concept is called “The Healthy Communities Funding Hub model,” and it offers a way to bridge a gap in many communities where there is no existing infrastructure for sustainably funding multi-sector (and multi-funding-stream) efforts to improve health.

At its core, a Healthy Communities Funding Hub would play a straightforward role: bringing together funding from various sources and coordinating spending to best address community health needs and goals. Its core functions would be:

  • Provide fiduciary oversight and management to coordinate multiple funding sources
  • Identify and leverage funding resources that are not typically coordinated
  • Govern the prioritization of spending on evidence-based interventions to ensure accountability to the target community
  • Serve as a trusted fiscal intermediary between sectors that affect health

Expert interviewees and workshop participants validated two other important components of the proposed Healthy Communities Funding Hub model:

  • Certification: The hub model would be a mechanism to help locally based organizations identify, secure, and coordinate funding streams. Certification could help establish this model’s credibility, bestow benefits to hubs, and could be structured to be adaptable to meet the needs of different communities.
  • Involvement from the health care system: To fully realize the hub model’s potential to improve health and reduce costs by coordinating funds to invest in prevention and nonclinical services, participation from the health care sector is critical, given the sector’s size and scope and its central role in service provision. Securing insurers’ and providers’ participation will likely require structures and incentives that make it easy for the health care system to participate and invest in hubs.

The social determinants of health can only be solved by collaborations across core societal institutions. By creating the backbone financial infrastructure for these collaborations, we can provide a sustainable foundation upon which we can begin to move from a sick care system to a health care system.

Want to learn more about the Healthy Communities Funding hub model? Read the full report here.

Author bio

Melissa is the health care research manager with Deloitte Services LP for the Deloitte Center for Government Insights. Prior to joining Deloitte, Melissa served as a health policy analyst at the Kaiser Family Foundation, where she conducted research and analysis on Medicaid, the uninsured, the Affordable Care Act (ACA), and the impact of health reform on low-income populations. She also produced and directed a number of video segments for the foundation about Medicaid enrollees’ experiences with the program and the issues facing people living with HIV as they transition to ACA insurance plans. Melissa received her bachelor of arts in philosophy from Binghamton University and her master of science in health policy from the Harvard T.H. Chan School of Public Health. There, she was selected for the distinguished Rappaport Public Policy fellowship and served as a fellow at the Massachusetts Health Exchange.