Strengthen Systems of Health

Goal 1:

Strengthen systems of health by catalyzing health systems to be accessible, equitable, and deliver health not just healthcare

This goal reflects our continuing commitment to building health systems that meet the needs of our communities and lead to improved health outcomes for all community members. We are convinced that there are sufficient resources in the system to improve health outcomes for all, if the resources are deployed equitably and effectively. We see our role as working in partnership with others to make the necessary changes in the system to realize this goal.

We have identified two outcomes that will lead to achievement of this goal. The first concerns the financing of the health sector; the second focuses on low-income and vulnerable populations. Within each outcome we have identified strategies that will serve as focused pathways through which we expect to make progress toward the outcome.

Targeted Outcome 1:

Resource allocation and system reform in the health sector reflect the goal of health, not just healthcare

We believe that a primary reason the US spends so much on health and gets so little in return is that we are spending too much money in the wrong places and not enough in the right places. This outcome is about using health sector dollars to finance improvement in health.

Historically, most providers in the healthcare system have been reimbursed according to how many services or procedures they provide. However, as healthcare costs have risen, our nation has embarked on the value conversation—asking whether we’re getting our money’s worth. Public and private health insurance payers including Texas Medicaid are increasingly paying healthcare providers for value rather than volume. If value is measured in terms of health outcomes, rather than medical services provided, then providers will be incented to do what it takes to meet those outcomes, including investing in nonmedical interventions that improve health.

Here’s an example. Many people with asthma suffer attacks that require acute medical attention because they are exposed to asthma triggers such as mold and insects in their own homes. Medications can alleviate asthma attacks, and we pay clinicians for prescribing such medications. What if the outcome we desired—and paid for—was not just medical management of asthma attacks, but avoiding attacks altogether? If we incented providers to prevent asthma attacks, they would discover that for many patients, home remediation of the triggers was the best investment. The movement toward value based care is creating a tectonic – and rapid – shift in the healthcare delivery system, and we are excited to help build capacity within community clinics and other organizations to respond to and succeed in this new environment.

Together, we will shift the delivery of care to more cost effective, outpatient settings within the community from the current acute and tertiary settings. From there we will move resources toward community prevention. Ultimately, we will obtain value in health not just in healthcare.

Strategy 1: Support Change In Healthcare Financing

Support change in healthcare financing to incent investment in improving community health

We expect to work with institutions that are willing to look at new ways of paying for improved health outcomes. Examples of this kind of work include Pay for Success initiatives that incent spending on prevention by inviting private sector investors to bear up-front costs and risk of failure; supporting community-based clinics in undertaking value-based contracts with payers; working with Texas Medicaid so that value-based payment programs incent investment in social determinants of health; and supporting the development of Accountable Health Communities.

Strategy 2: Work Upstream

Support community-based clinics to address social determinants of health

We will continue to work toward resource allocation to support improved health outcomes, with a focus on community-based clinics that want to move upstream and address their patients’ health, not just their medical needs. We will continue our Community Centered Health Homes (CCHH) initiative, which provides clinics with coaching, technical assistance, a learning community, and grant funding to enable them to lead in the space of community prevention. We will also support clinics in collecting, analyzing, and acting on data and information on the social determinants of health that impact their patients. We believe these clinics play a critical role in their communities, and we want to help them leverage that role in a rapidly changing environment.

Targeted Outcome 2:

Low-income and vulnerable populations access comprehensive care in their communities

This outcome focuses on the health of low-income and vulnerable populations by ensuring that they have access to health services through community-based clinics.

Strategy 3: Support Comprehensive Clinics

Support community-based clinics to provide comprehensive services, continuity of care, inclusivity, and efficiency in delivery of care

This strategy reflects our interest in helping community-based clinics fulfill their potential on behalf of their patients and communities. We define comprehensive community-based clinics as those that provide a full complement of services, including preventive, primary care, behavioral health services, and oral health services. These clinics offer the full array of services including immunization and women’s reproductive health services; they charge patients according to a sliding scale; they participate in reimbursement systems; and they seek out a variety of sources of funding for sustainability.

Through learning collaboratives, technical assistance, and grantmaking, we will support clinics to provide comprehensive care: preventive care, primary care, behavioral health services, and oral health services. Because the community-based clinics are the connection between their patients and the larger healthcare delivery system, we will support clinics to build strong referral networks to ensure their patients have continuity of care including access to specialty and acute care not available at the clinic. Community-based clinics should be inclusive and welcoming to many populations, acquiring the cultural competencies necessary to serve all community members. We also believe that community-based clinics can and should operate efficiently. For long-term sustainability, they must cultivate a diversity of revenue sources including public and private payers, adhere to the highest operational standards (for example, adopting Patient Centered Medical Home or Integrated Behavioral Health models), and seek out opportunities to improve quality of services while reducing costs through collaborations and shared resource structures.

Strategy 4: Strengthen Rural Health

Expand and strengthen community-based clinics in rural areas

While Strategy 3 aims to improve the performance of community-based clinics generally, Strategy 4 is a special call-out to our rural communities, many of which lack basic preventive, primary, behavioral, and oral health services. Through this strategy, we will work to increase the availability of these basic services to those living in smaller towns and rural areas. We expect to work with communities to help them optimize healthcare infrastructure, including communities that have depended on rural hospitals whose futures are in jeopardy.

Strategy 5: Expand Health Coverage & Benefits

Expand health coverage for low-income and vulnerable populations

Strategy 5 recognizes that true access to health services requires a system of coverage, ideally through a comprehensive health insurance plan. People who are insured have greater access to care and have better health outcomes, including lower mortality rates, than those who are uninsured. Low-income and vulnerable populations are less likely to have health insurance than the general population, leaving them at greater risk. This is especially true in Texas where we have the highest percentage and largest number of uninsured residents of any state. Moving the needle on this issue will require a dual approach to both expand coverage and improve enrollment of eligible beneficiaries.

In support of this strategy, we will continue our research and advocacy regarding the need to increase health insurance coverage in our state, and we will continue to support organizations that help low-income and vulnerable populations gain access to care through insurance and other health-related programs including those offered by federal, state, and local governments.