Articles

Key Takeaways from EHF’s Policy and Research Reports in 2024

As a major health philanthropy in Texas, EHF has developed a diverse range of tools, both financial and non-financial, that help to improve the health of all Texans.
Shao-Chee Sim | EHF

As a major health philanthropy in Texas, EHF has developed a diverse range of tools, both financial and non-financial, that help to improve the health of all Texans. In addition to providing grants to organizations and communities across the Episcopal Diocese of Texas (EDOT), we have supported congregations and community coalitions to address health challenges and engaged in policy research to inform and influence the health policy agenda in Texas.  

In 2024, EHF published several timely and diverse policy research reports, partnered with Texas Health and Human Services Commission (HHSC) in educating community health workers (CHWs) and doulas on the rollout of HB1575, and supported peer learning collaboratives of Medicaid health insurance plans. Rather than relying on a singular discipline or methodology, we applied a “triangulated” approach and “multi-disciplinary” principle in our policy research efforts.  

We also funded statewide public opinion polls, economic cost analyses, program evaluations, primary care capacity assessments, and environmental scans. To better understand their lived experience, we captured the important voices of CHWs and Medicaid beneficiaries through focus group and survey approaches.  

While we encourage readers to download the complete reports and learning session summaries.

Below are some key highlights and themes from our policy and research reports.

Accessing and affording healthcare continues to be a challenging experience for Texans.

The EHF/SSRS annual Texas health policy tracking poll report showed that nearly half of Texas adults have difficulty affording health care, with significant disparities by race and ethnicity as well as household income and age. Due to the high cost of medical care, two-thirds of Texas adults skip or postpone getting the health care they need.

Even with 3.4 million Texans now accessing affordable health insurance coverage via the Affordable Care Act (ACA) marketplace, the state continues to have the highest uninsured rate in the country. While the Texas legislature extended Medicaid postpartum health insurance coverage to 12 months during the last session, more can be done to expand affordable health care coverage to Texans.   

Analyzing diabetes costs reveals that it is a significant cost driver of Medicaid expenditures in Texas.

Based on analysis of Medicaid claims data provided by several health insurance plans and the Transformed Medicaid Statistical Information System, Milliman estimated that diabetes-related health care costs added up to between $6 billion and $8 billion annually to Texas Medicaid. That represents 23%-30% in total Medicaid spending for adults.

The report offered two important recommendations: 1) the implementation of diabetes screening practices that are consistent with clinical practices, and 2) investment in programs that can effectively reduce the incidence of diabetes. Given how little attention and resources have been devoted to preventing diabetes at the state level, the report put forth a much-needed economic argument for preventive measures.

Understanding the economic impact of health disparities at the county level has proven useful for improving community health.

After the passage of HB12 and HB1575 during the last legislative session, there has been growing interest to understand the perspectives of CHWs and Medicaid beneficiaries as HHSC began implementation of both bills in 2024.  Three timely EHF-supported reports offered great insights and perspectives of CHWs and Medicaid beneficiaries as the implementation of HB12 and HB1575 began.

The CHW workforce study, Community Health Worker Workforce and Implications For Sustainability: A Texas Landscape Scan, which is supported by Texas Department of State Health Services and Texas Association of Promotores and Community Health Workers, highlighted the diversification of the CHW workforce, employer composition and training needs. More than 70% of the survey respondents expressed interest in learning more about participating in the Medicaid program after the passage of HB1575 allowing Medicaid reimbursement for CHW services for children and pregnant women on Medicaid. 

Two Medicaid beneficiaries focus group research projects (Engaging Medicaid Members: Assessing Health Literacy and Channels for Member Engagement and Engaging Medicaid Members: Identifying the Non-Medical Needs of Pregnant Members) supported by EHF, St. David’s Foundation, Methodist Healthcare Ministries and the Michael & Susan Dell Foundation, were led by researchers at Treaty Oak Strategies and several Medicaid health insurance plans.

These reports addressed Medicaid beneficiaries’ understanding of their health insurance benefits, knowledge of HB12 postpartum coverage expansion, health plan communication channels, as well as various non-medical needs they face during their pre-natal period.

Overwhelmingly, Medicaid beneficiaries expressed that text messaging was the best way to reach them. Most said they do not access the website of their health insurance plans. Both project findings were discussed extensively among health plans and it’s rewarding to hear some plans have made changes in their internal protocols to better engage their members.   

Demonstrating positive evidence and impacts of NMDOH interventions in Texas Medicaid offers substantial insights.

EHF continued to support several evaluations of health plan-supported interventions focused on non-medical drivers of health (NMDOH).

In Opportunities to Address the Non-Medical Drivers of Health in Texas: A Review of Food, Community Health Worker and Non-Medical Perinatal Interventions, and Alternative Payment Models, the Center for Healthcare Strategies presented evidence-based examples of MCO-led interventions related to: (1) food and nutrition; (2) CHW services; and (3) NMDOH case management for pregnant women, including social risk factor screening. It also outlines recommendations for HHSC to consider for alternative payment models and coverage options to pay for and provide these NMDOH approaches.

In the Waco Connect Project: Health Plan Referrals Evaluation Report and the Waco Connect Project: Law Enforcement Evaluation Report, researchers at Texas A&M University  identified two important short-term outcomes of “social care coordination” interventions: 1) less police time spent on behavioral health calls and 2) reductions in the number of emergency department visits. Both are promising outcomes from the Waco Connect “social care coordination” pilot projects. 

Learning about EDOT’s primary care sector reveals current challenges and opportunities for growth and collaboration.

As the safety-net health care delivery system and community demographics continue to evolve within our service area, EHF, in partnership with several peer funders, published two reports: Greater Houston Primary Care Safety Net: Post COVID Growth and Challenges and Primary Care Capacity Assessment in Central Texas.

Both reports, developed by two Texas-based consulting firms – Working Partners and Decision Information Resources – offered very detailed data and insights about the growth, challenges, and opportunities to support the primary care sector in two major regions of EDOT.

In Evaluation of the Texas Organization of Rural & Community Hospitals Clinically Integrated Network, researchers at NORC and Texas A&M provided a great recap of the development of TORCH CIN, which includes 32 participating hospitals—rural acute care hospitals and critical access hospitals (CAHs)—and their affiliated rural health clinics (RHCs) and primary care practices. Through collaborative engagement with the TORCH CIN, researchers suggested that there is an opportunity to innovate and design new alternative payment models in partnership with policymakers and payers like the CMS Innovation Center, Medicare Advantage, MCOs, and other payers. 

In 2024, EHF began its Digging Deeper blog series. My colleague Briana Martin published a recap article summarizing the various articles written by EHF staff, collaborators, and partners.

Additionally, EHF continued to assume a leadership role in supporting the annual Texas MCO NMDOH learning collaborative, partnering with HHSC to offering CHW and doula stakeholder engagement sessions amidst the rollout of HB1575, and facilitating education and strategy sessions across the three regions in Texas interested in applying for the ARPA-H HEROES federal funding. To educate stakeholders and promote peer learning, summaries and presentation slides from these sessions can be found here 

It is also worth noting that EHF policy, convening, and research engagement efforts contributed to two major HHSC reports of the State Legislature by the end of 2024: Texas Value-Based Payment and Quality Improvement Advisory Committee Recommendations to the 89th Texas Legislature (December 2024); and HHSC’s Rural Hospital Services Strategic Plan Progress Report (November 2024).  

We hope you will find these 2024 reports, learning sessions and resources helpful in your own work. Stay tuned for new policy, research reports, blog articles, and updates in 2025!  

More from Digging Deeper

Digging Deeper Digest: 2024 Recap

This year, EHF’s Research and Evaluation team launched “Digging Deeper,” collaborating with trusted partners to analyze the research topics and health trends that are central to EHF’s vision for a healthier Texas.

Read More »

National Diabetes Month 2024: Insights from Recent EHF Learnings

Crosscutting themes surfaced from EHF’s learning and exploration of diabetes prevention interventions. Opportunities exist to increase screening to address health disparities in prediabetes and diabetes and for Texas Medicaid to explore funding models to include the CDC’s National Diabetes Prevention Program (DPP) as a reimbursable service with the intention to

Read More »

The Promises of Community Paramedicine: GLOW Evaluation Update

Community paramedicine models of care provide a strategy that is working across the nation to address non-medical drivers of health. There is a growing body of evidence that programs like GLOW can address needs of the community that are beyond the capacity and reach of our traditional medicine model of

Read More »