EHF desires to work with institutions that are willing to look at new ways of paying for improved health outcomes. We invite proposals that address innovative programs to pilot, transition, and scale approaches that change the way in which positive health outcomes are financially rewarded.
Examples of the types of investments EHF has considered under this strategy include, but are not limited to, the
• Pay for success initiatives: piloting models that incent spending on prevention by inviting private sector investors to bear up-front costs as well as risk of failure
• Incenting investment in social determinants of health: working with Texas Medicaid, local governments, managed care organizations, and other payors to align value-based payment program incentives and other payment structures with interventions that address social determinants of health
• Multi-sector, health-focused community collaboratives: supporting collaboratives that are testing innovative sustainable funding models such as CAPGI and Wellness Funds
Social determinants of health (SDOH) are broadly defined as “the conditions in which people are born, grow, live work and age” and may include economic stability, neighborhood and physical environment, education, food, community and social context, and the health care system. EHF is interested in incenting clinics to target these upstream factors that influence population health, beyond what the health care system has historically been able to address on its own.
EHF will continue to support the Community-Centered Health Home (CCHH) practice. EHF’s Texas CCHH Initiative worked with a group of clinics to develop specific ways for them to go beyond clinic walls and take community action to prevent illness and poor health. We encourage participating clinics to continue their CCHH work and consider ways in which that work can advance policy, systems, and environmental changes where appropriate.
For clinics interested in adopting the CCHH practice, multi-year funding will be used to create a glidepath to assist clinics in learning and adopting its principles and practices. We anticipate that during the first year, clinics will learn to recruit and engage clinic leadership including physicians, staff, and board members, identify and outreach to community service agencies with whom to partner, analyze data based on research of population/community health issues and the social determinants that impact them, to form the basis for developing a plan that moves the community to action.
Clinics will have access to the following online resources and tools:
• CCHH Logic Model
• CCHH Principles and Practices
• Healthy Places Toolkit: A Practical Guide to Improving Community Health
• Access to academic and foundation articles relating to community health models and community resource referral platforms
• Access to community engagement facilitation tools and resources
• Connection with current CCHH participating clinics who can support new clinics with their learning and serve as trusted resource to answer questions”
Clinics interested in adopting the CCHH practice must speak with a Program Officer in advance of submitting a Letter of Inquiry.
EHF will continue to prioritize the Clinics’ Pathway Approach (CPA) that builds clinics’ fundamental capacities for population health work and value-based payment system design (please see CPA Logic Model). Please note, clinics currently participating in the CPA learning cohort do not need to reapply for continued CPA funding. Your Program Officer will reach out to assist with any necessary modifications to your existing application prior to consideration by the EHF board. At this time, we will not be accepting LOIs or applications from additional clinics. If your clinic is not currently in the CPA initiative and you are interested in joining, please contact firstname.lastname@example.org.
EHF will continue to devote resources to support clinics to provide the full spectrum of comprehensive primary care though priority will be given to support:
• Comprehensive reproductive health services: guided by the World Health Organization’s definition of reproductive health, increasing access to, expanding accountability, and improving quality of reproductive health care including, but not limited to:
Breast and cervical cancer screening (including mammography)
Sexually Transmitted Infection screening and treatment
Adolescent reproductive care (including that offered in the pediatric practice)
Perinatal care (including preconception, prenatal, postpartum, and pediatric care)
We refer applicants to the Centers for Disease Control and Prevention Providing Quality Family Planning Services (QFP) guidelines for evidence-based reproductive health resources to inform this work. We also call particular attention to the critical importance of culturally respectful, client-centered, and client-driven approaches to reproductive health service.
• Integrated behavioral health services (IBH): bringing behavioral health services into a primary care setting, bringing primary care services into a behavioral health setting, or bringing substance use disorder services into either a primary care or a behavioral health setting. The SAMHSA (Substance Abuse and Mental Health Services Administration) Center for Integrated Health Solutions has developed a framework to help primary and behavioral health care provider organizations improve outcomes by helping them understand where they are on the integration continuum. Applicants interested in applying for this priority should review this website when developing their proposals.
We are particularly interested in IBH approaches that attend to the unique needs of expectant people and primary caregivers of children in the first three years of life.
• Organizational partnerships: for clinics interested in partnering with other clinics to optimize service delivery, operational strength or improve financial stability, proposals should outline the partnership and path towards service consolidation. Before such a grant is approved, a Memorandum of Understanding between/among the clinics must be executed.
This strategy is aimed at those living in smaller towns and rural areas. EHF is interested in work that increases the availability of basic preventive, primary, behavioral, and oral health services that are connected to the broader community and health system.
Examples of this work include but are not limited to:
• Offering technical assistance or operating support for rural health clinics to provide outpatient primary care services
• Developing approaches to recruit and/or retain provider staff including nurse practitioners and other mid-level providers
• Enhancing use of information technology and data analytics
• Supporting other practices that improve the sustainability and function of rural health clinics
A new priority in this Strategy is support for Health Resource Centers (HRCs)–organizations that facilitate access to health care by coordinating social service agencies that address various social determinants of health. HRCs may also provide technical assistance, information, tools, and resources for the improvement of rural health.
EHF will continue support grants for behavioral health services in non-integrated settings because we recognize the avioral health services in these locations.
EHF will fund clinics and community-based organizations to help low-income populations gain access to care through enrollment in insurance and other health-related programs, including those offered by federal, state, and local governments. Funds will support dual approaches that expand coverage and improve enrollment of eligible beneficiaries, and advocacy efforts to increase health insurance coverage in Texas including the expansion of Medicaid.
EHF is particularly interested in:
- Proposals that use innovative approaches to track newly-enrolled beneficiaries through their first use of those benefits, most commonly through a visit with a medical provider or utilization of closed loop referral processes.
- Strategic partnerships that expand the enrollment ecosystem with key community partners such as schools, to find children and family members who could be eligible for health insurance coverage and other community benefits.
- Community engagement strategies to enhance consumer understanding of health benefits, identify health issues, develop local priorities and expand enrollment to new service areas such as rural communities.
- Innovative uses of strategic outreach, field navigators and partnership engagement specialists as part of the enrollment team to increase the ability to perform field enrollments and expand engagement to uninsured eligible individuals.
Organizations may also consider efforts that strengthen the enrollment eco-system by including advocacy supports that increase health insurance coverage in Texas, technical assistance supports that build the capacity of enrollment assisters, and efforts that maximize the impact and strengthen the work of enrollment-based coalitions.