Social Determinants of Health and Community Based Organizations
Subcommittee Meeting #2
August 19, 2015
2
Agenda
1. Review of Roadmap Questions
2. Subgroup Findings and Discussion
3. Guidelines for Providers and the State
4. Housing Determinants
5. Capturing Savings Across Public Spending
3
Roadmap Questions: SDH What methods exist for
measuring SDH
Categories?
How do we measure
providers’
performance related to
impacting SDH
What are the
recommended outcomes
for each SDH category?
What methods can be
used to capture savings
across public spending?
Focus of SDH & CBO
Subcommittee
How do we prioritize which Social
Determinant to focus on first?
How do we address
housing
determinants and
develop an action
plan?
Questions currently being addressed by the Subgroup formed after Meeting #1
How will the State
incentivize providers
to invest VBP savings
in Social
Determinants?
What changes would
improve outcomes and
lower cost of care?
4
Roadmap Questions: SDH
What methods can be
used to capture savings
across public spending?
How do we measure
providers’
performance related to
impacting SDH
These remaining
questions will drive much
of the discussion today…
How do we address
housing
determinants and
develop an action
plan?
How will the State
incentivize providers
to invest VBP savings
in Social
Determinants?
5
SDH Subgroup Findings and
Discussion
6
SDH Categories
The Subgroup identified and began evaluating social determinants across the
following five categories:
ƒ Economic Stability
ƒ Education
ƒ Health and Healthcare
ƒ Social, Family and Community
ƒ Neighborhood and Environment
7
Subgroup Focus Areas
The following were considered when evaluating social determinants:
ƒ Does it have a standard metric for measurement?
ƒ What interventions are currently being done with success?
ƒ What are the costs of the interventions?
ƒ What health outcomes do they produce?
ƒ What are the net financial impacts?
ƒ What is the strength of evidence behind the health outcomes?
ƒ Are there any resources that can be leveraged and how available are they?
ƒ What is the population health objective?
ƒ What is the social impact?
ƒ Are there any identifiable co-beneficiaries (outside VBP modality)?
The slides that follow
present the research
conducted to date by the
Subgroup on the identified
social determinants. This
is draft for the purposes of
discussion with
Subcommittee.
8
Economic Stability
-Economic Instability Poverty, and Lack of Employment
-Homelessness and Housing Instability
-Food Insecurities and Lack of Access to Healthy Food
-Lack of Transportation
9
Economic Instability Poverty, and Lack of Employment
Standard
Metric
(yes/no)*
Yes:
Employment
status
Interventions
Case management/entitlement
assistance with disability
benefits/public assistance/other
subsistence benefits
Financial incentives for medication
adherence and/or other health
behaviors
Provision of child care
Provision of benefits counseling for
persons moving from entitlement
programs to employment
Referral to vocational rehabilitation
services
Credentialing programs for peer
specialist community health
workers in OASAS, Office of
Mental Health, DOH and other
Medicaid funded programs to
provide one avenue for return to
work
Availability of
Net
Strength of Evidence LeverageIntervention
Resources that
Health Outcome Financial re Health Outcomes
able
Cost
can be
Impact
(w/references)
Resources
Leveraged
Improved
physical and
mental health
quality of life
Improved
physical and
mental health
quality of life
Improved
physical and
mental health
quality of life
Medium - longitudinal
research needed
Strong
DRAFT IN PROGRESS
Population
Health
Objective
Identifiable
CoSocial
Beneficiaries
Impact
(outside VBP
modality)
10
Homelessness and Housing Instability
Standard
Metric
(yes/no)*
Yes
Interventions
Intervention Cost
Health Outcome
Identifiable
Strength of
Availability of
Net
LeveragePopulation
CoEvidence re
Resources that
Financial
able
Health
Social Impact Beneficiaries
Health Outcomes
can be
Impact
(outside VBP
Resources
Objective
(w/references)
Leveraged
modality)
Respite care
$2,000 - $2,500 monthly Reduced
readmission/ER visits
Very strong
Rental assistance
$400 - $1,000 monthly Increased health
stability
Very strong
Legal services
Very strong
Housing related
$300 - $500 monthly
case management
services
Supportive housing $1,500 - $2,000 monthly Health stabilization &
capacity for continuous
monitoring &
intervention
Strong
Universal
access to
safe &
affordable
housing
Section
8/TANF
Legal services
Very strong
Better health outcomes
Reduction in
disparities in care
Reduction in health
care cost
DRAFT IN PROGRESS
Ending
Shelter
homelessness systems
& housing
instability
Jails
Emergency
rooms
11
Food Insecurities and Lack of Access to Healthy Food
Standard
Metric
(yes/no)*
Interventions
Intervention
Cost
Health Outcome
SNAP (Supplemental Nutrition
Assistance Program )/WIC
BMI/Chronic Disease
Prevention
SBP (School Breakfast
Program)
Summer Food Service
Program
BMI/Chronic Disease
Prevention
BMI/Chronic Disease
Prevention
Child & Adult Food Care
Program
Farmers Market WIC
Couponing
Fruit & Vegetable Rx
BMI/Chronic Disease
Prevention
BMI/Chronic Disease
Prevention
BMI/Chronic Disease
Prevention
Identifiable
Strength of
Availability of
Net
LeveragePopulation
CoEvidence re
Resources that
Financial
able
Health
Social Impact Beneficiaries
Health Outcomes
can be
Impact
(outside VBP
Resources
Objective
(w/references)
Leveraged
modality)
Very strong
Access to
Ending
Schools
high quality hunger;
nutritious
reducing
foods for
poverty
improved
health
DRAFT IN PROGRESS
Oral health
care
Community
markets, local
business
12
Lack of Transportation
Standard
Metric
(yes/no)*
Interventions
Intervention
Cost
Health Outcome
Identifiable
Strength of
Availability of
Net
LeveragePopulation
CoEvidence re
Resources that
Financial
able
Health
Social Impact Beneficiaries
Health Outcomes
can be
Impact
(outside VBP
Resources
Objective
(w/references)
Leveraged
modality)
Not started
DRAFT IN PROGRESS
13
Education
-Lack of Education and/or Educational Disparities
14
Lack of Education and/or Educational Disparities
Standard
Metric
(yes/no)*
Interventions
Identifiable
Strength of
Availability of
LeveragePopulation
CoIntervention
Net Financial
Evidence re
Resources that
Health Outcome
able
Health
Social Impact Beneficiaries
Cost
Impact
Health Outcomes
can be
(outside VBP
Resources
Objective
(w/references)
Leveraged
modality)
Advocacy regarding accessing
and optimizing public
programs:
Health literacy
PreK to 12 Education
Chronic Disease
Prevention
Early childhood/Head Start
Trauma reduction
Summer programs
Even Start
Tutoring programs
Classroom supports (reduction
in class size, teacher training)
Health literacy education
DRAFT IN PROGRESS
Various public
programs
Improved
Reduction in
health literacy poverty
and ability to
effectively
engage
Schools
15
Health and Healthcare
-Lack of Healthy Behaviors
-Lack of Health Literacy Skills
-Lack of Follow-up Care in Community PostHospitalization
-Lack of Regular Healthcare Provider Visits
-Lack of Vaccinations
-Disparities in Linkages to Social Environments
-Lack of Transportation for Healthy Needs
-Disparities in Linkages to Insurance Coverage
-Lack of Advanced Directives
-Disparities in Access to Culturally Competent
Staff and Staff Training
-Lack of Adequate Nutrition
-Disparities in Access to Affordable Housing
-Disparities in Access to Adequate Food
-Lack of Access to Adequate and Affordable
Health Insurance
-Disparities in Access to Appropriate
Transportation
-Lack of Socialization
-Disparities in Access to Entitlements, Benefits,
and Other supports for Independent Living
16
Lack of Healthy Behaviors
Standard
Metric
(yes/no)*
Interventions
Community Based
Care Coordination
Community Based
Case Management
Home Care
Senior Centers
Social Adult Day Care
Adult Day Health Care
Housing with Services
Client Centered
Technologies
Identifiable
Strength of
Availability of
LeveragePopulation
CoIntervention
Net Financial
Evidence re
Resources that
Health Outcome
able
Health
Social Impact Beneficiaries
Health Outcomes
Cost
Impact
can be
(outside VBP
Resources
Objective
(w/references)
Leveraged
modality)
Better disease
prevention in
overall
populationincreased
wellness in the
chronically ill
DTFA, DOH,
SOFA,
HRA,ACS
DRAFT IN PROGRESS
Better
disease
prevention in
overall
populationincreased
wellness in
the
chronically ill
Decreased
healthcare
costshealthier
population
17
Lack of Health Literacy Skills
Standard
Metric
(yes/no)*
Interventions
Community Based Care
Coordination
Community Based Case
Management
Home Care
Senior Centers
Social Adult Day Care
Adult Day Health Care
Housing with Services
Client Centered
Technologies
Availability
Strength of
Net
Leverageof
Intervention
Evidence re Health
Health Outcome Financial
able
Resources
Cost
Outcomes
Impact
Resources that can be
(w/references)
Leveraged
Better educated
DTFA,
healthcare
DOH,
consumers with
SOFA,
enhanced ability
HRA,ACS
to navigate the
healthcare system
and make
appropriate
healthcare
decisions
DRAFT IN PROGRESS
Identifiable
CoPopulation Health
Social Impact Beneficiaries
Objective
(outside VBP
modality)
Better educated
Healthier, more
healthcare consumers educated
with enhanced ability to consumers
navigate the healthcare better able to
system and make
make informed
appropriate healthcare decisions and
decisions
navigate
healthcare
system
18
Lack of Follow-up Care in Community PostHospitalization
Standard
Metric
(yes/no)*
Interventions
Home Care
Community Care
Transitions
Housing with Services
Availability
Strength of
Net
Leverageof
Intervention
Evidence re Health
Population Health
Health Outcome Financial
able
Resources
Cost
Outcomes
Objective
Impact
Resources that can be
(w/references)
Leveraged
Fewer
DTFA,
Fewer unnecessary
unnecessary ER
DOH, SOFA
readmissions
visits, admissions,
readmissions
Identifiable
CoSocial Impact Beneficiaries
(outside VBP
modality)
Decreased
healthcare
costs-healthier
population
Lack of Regular Healthcare Provider Visits
Standard
Metric
(yes/no)*
Interventions
Community Based Care
Coordination
Home Care
Availability
Strength of
Net
Leverageof
Intervention
Evidence re Health
Health Outcome Financial
able
Resources
Cost
Outcomes
Impact
Resources that can be
(w/references)
Leveraged
Better disease
DTFA,
prevention in
DOH, SOFA
overall populationincreased
wellness in the
chronically ill
DRAFT IN PROGRESS
Population Health
Objective
Better disease
prevention in overall
population-increased
wellness in the
chronically ill
Identifiable
CoSocial Impact Beneficiaries
(outside VBP
modality)
Healthier
population
19
Lack of Vaccinations
Standard
Metric
(yes/no)*
Interventions
Community Based Care
Coordination
Community Based Case
Management
Home Care
Senior Centers
Social Adult Day Care
Adult Day Health Care
Housing with Services
Availability
Strength of
Net
Leverageof
Intervention
Evidence re Health
Health Outcome Financial
able
Resources
Cost
Outcomes
Impact
Resources that can be
(w/references)
Leveraged
DTFA,
Fewer cases of
DOH, SOFA
preventable
disease, i.e. flu,
pneumonia
particularly in frail
elderly
DRAFT IN PROGRESS
Population Health
Objective
Fewer cases of
preventable disease,
i.e. flu, pneumonia
particularly in frail
elderly
Identifiable
CoSocial Impact Beneficiaries
(outside VBP
modality)
Healthier
populationdecreased
healthcare
dollars spent
on preventable
illness
20
Disparities in Linkages to Social Environments
Standard
Metric
(yes/no)*
Interventions
Community Based
Care Coordination
Community Based
Case Management
Senior Centers
Social Adult Day Care
Adult Day Health Care
Client Centered
Technologies
Intervention
Cost
Health Outcome
Decrease feelings of
social isolation and the
cognitive, behavioral,
and physiological
consequences of
loneliness
Decrease incidence of
Depression
Increased mortality risk
enhanced opportunity
for recreational and
leisure activities
Availability
Strength of
of
Net
LeveragePopulation Health
Evidence re
Resources
Financial
able
Objective
Health Outcomes
Impact
Resources that can be
(w/references)
Leveraged
DTFA,
Minimize feelings of
DOH, SOFA
social isolation and the
cognitive, behavioral,
and physiological
consequences of
loneliness
Decrease depression
Increased mortality risk
DRAFT IN PROGRESS
Identifiable
CoSocial Impact Beneficiaries
(outside VBP
modality)
Healthier,
happier
population
Lower
incidence of
mental illness,
criminal
behavior, and
depression
21
Lack of Transportation for Healthy Needs
Standard
Metric
(yes/no)*
Interventions
Community Based
Care Coordination
Community Based
Case Management
Social Adult Day Care
Adult Day Health Care
Intervention
Cost
Health Outcome
Better disease
prevention in overall
population-increased
wellness in the
chronically ill
Availability
Strength of
of
Net
LeverageEvidence re
Resources
Financial
able
Health Outcomes
Impact
Resources that can be
(w/references)
Leveraged
DTFA,
DOH,
SOFA,
HRA,ACS
DRAFT IN PROGRESS
Identifiable
CoPopulation Health
Social Impact Beneficiaries
Objective
(outside VBP
modality)
Better disease
Reduction in
prevention in overall number of people
population-increased who are unable to
wellness in the
obtain, or delay
chronically ill
obtaining health
care-healthier
population
22
Disparities in Linkages to Insurance Coverage (e.g.,
Medicare, Medicaid, Managed Care)
Standard
Metric
(yes/no)*
Interventions
Community Based
Care Coordination
Community Based
Case Management
Home Care
Senior Centers
Social Adult Day Care
Adult Day Health Care
Housing with Services
Intervention
Cost
Health Outcome
Improve access to
health care to result in
better disease
prevention in overall
population-increased
wellness in the
chronically ill
Availability
Identifiable
Strength of
Net
Leverageof
CoEvidence re
Population Health
Financial
able
Resources
Social Impact Beneficiaries
Health Outcomes
Objective
(outside VBP
Impact
Resources that can be
(w/references)
Leveraged
modality)
Better disease
Reduction in
DTFA,
prevention in overall number of people
DOH, SOFA
population-increased who are unable to
wellness in the
obtain, or delay
chronically ill
obtaining health
care-healthier
population.
Lower healthcare
costs
Greater number
of individuals with
specific source of
ongoing care
DRAFT IN PROGRESS
23
Lack of Advanced Directives
Standard
Metric
(yes/no)*
Availability
Identifiable
Strength of
Net
Leverageof
CoIntervention
Evidence re
Population Health
Interventions
Health Outcome
Financial
able
Resources
Social Impact Beneficiaries
Cost
Health Outcomes
Objective
(outside VBP
Impact
Resources that can be
(w/references)
Leveraged
modality)
Community Based
Encourage patient
DTFA,
Encourages patient Decreased
Care Coordination
autonomy-provide
DOH, SOFA
autonomy
dollars expended
Community Based
individuals with the
Provides individuals on expensive,
opportunity to state their
Case Management
with the opportunity unwanted end of
goals regarding health
Home Care
to state their goals life care
and medical treatment
Senior Centers
regarding health and based on personal
Social Adult Day Care
medical treatment values, attitudes, and
Adult Day Health Care
based on personal beliefs surrounding
Housing with Services
values, attitudes,
health care, illness, and
and beliefs
death-decreases
surrounding health
opportunity for
care, illness, and
unwanted, costly
death-decreases
healthcare treatment at
opportunity for
end of life
unwanted, costly
healthcare treatment
at end of life
DRAFT IN PROGRESS
24
Disparities in Access to Culturally Competent Staff
and Staff Training
Interventions
Community Based
Care Coordination
Community Based
Case Management
Home Care
Senior Centers
Social Adult Day Care
Adult Day Health Care
Housing with Services
Client Centered
Technologies
Intervention
Cost
Health Outcome
Mutual respect, trust and
understanding between patients and
caregivers; minimizing barriers to
healthcare and health literacy by:
• Promoting more equitable
inclusion of all community
members in the healthcare
system
• Assisting patients and families to
participating in their care
• Promoting patient and family
responsibility for participating in
their healthcare
• Improving patient data collection
and communication of health
information
• Increasing incidence of
preventive care by patients-fewer
missed visits
• Increasing cost savings from a
reduction in medical errors,
volume of treatments and legal
costs
Availability
Strength of
Net
of
Identifiable
Evidence re Leverage-able
Social
Financial
Resources
Population Health Objective
CoHealth
Resources
Impact
Impact
that can be
Beneficiaries
Outcomes
Leveraged
Department for
Mutual respect, trust and
More
the Aging
understanding between patients and educated and
(DFTA),
caregivers; minimizing barriers to
engaged
Department of
healthcare and health literacy by:
healthcare
Health (DOH),
• Promoting more equitable
consumers
inclusion of all community
with fewer
State Office for
members in the healthcare
marginalized
the Aging
system
individuals,
(SOFA), Human
• Assisting patients and families to groups
Resource
participating in their care
Administration
• Promoting patient and family
(HRA),
responsibility for participating in
Administration
their healthcare
for Children's
• Improving patient data collection
Services (ACS)
and communication of health
information
• Increasing incidence of preventive
care by patients-fewer missed
visits
• Increasing cost savings from a
reduction in medical errors,
volume of treatments and legal
costs
DRAFT IN PROGRESS
25
Lack of Adequate Nutrition
Standard
Metric
(yes/no)*
Availability
Strength of
Net
Leverageof
Intervention
Evidence re
Interventions
Health Outcome
Financial
able
Resources
Health Outcomes
Cost
Impact
Resources that can be
(w/references)
Leveraged
Community Based
Decreased risk of heart
DTFA,
Care Coordination
disease, diabetes,
DOH,
Community Based
obesity, bone loss and
SOFA,
Case Management
osteoporosis, and other
HRA,ACS
Home Care
chronic diseases
Senior Centers
Enhanced brain health
Social Adult Day Care
Enhanced growth
Adult Day Health Care
(during childhood and
Housing with Services
pregnancy), healing and
Client Centered
the maintenance and
Technologies
development of healthy
muscle mass
DRAFT IN PROGRESS
Population Health
Objective
Decreased incidence
of costly chronic
illnesses such as
heart disease,
diabetes, obesity,
bone loss and
osteoporosis,
alzheimers
Enhanced growth
(during childhood
and pregnancy),
healing and the
maintenance and
development of
healthy muscle mass
Identifiable
CoSocial Impact Beneficiaries
(outside VBP
modality)
26
Disparities in Access to Affordable Housing
Standard
Metric
(yes/no)*
Interventions
Housing with Services
Intervention
Cost
Health Outcome
Reduction of stress and
its adverse health
outcomes
Frees up resources to
be spent on proper
nutrition and healthcare
Reduction in health
problems associated
with substandard
housing
Provide more stable
environment for delivery
of healthcare services
Strength of
Net
Evidence re
Financial
Health Outcomes
Impact
(w/references)
Leverage-able
Resources
NYC Housing
Authority (NYCHA),
Home Sharing
Programs, Section 8,
SCRIE, DRIE, NYS
Housing & Community
Renewal (HCR), NYC
Housing Preservation
& Development (HPD)
DRAFT IN PROGRESS
Identifiable
Availability of
Population
CoResources
Health Social Impact Beneficiaries
that can be
Objective
(outside VBP
Leveraged
modality)
Collage
Shelter for Less Homeless
PAM
frail elderly Caregiver stres
reduction
27
Disparities in Access to Adequate Food
Standard
Metric
(yes/no)*
Interventions
Meals on Wheels
Senior Centers
Intervention
Cost
Health Outcome
Decreased risk of
heart disease,
diabetes, obesity,
bone loss and
osteoporosis, and
other chronic
diseases
Enhanced brain
health
Enhanced growth
(during childhood and
pregnancy), healing
and the maintenance
and build-up of
muscle mass
Strength of
Net
Evidence re
Financial
Health Outcomes
Impact
(w/references)
Leverage-able
Resources
SNAP, Senior
centers, City Meals
on Wheels, DFTA
MOW
DRAFT IN PROGRESS
Identifiable
Availability of
Population
CoResources
Health Social Impact Beneficiaries
that can be
(outside VBP
Objective
Leveraged
modality)
Nutrition to Less hunger
at risk
and
populations malnutrition
to increase
overall
population
health
28
Lack of Access to Adequate and Affordable Health
Insurance
Standard
Metric
(yes/no)*
Interventions
Community Based
Case Management
Care Transitions
Home Care
Intervention
Cost
Health Outcome
Increased access to
healthcare resulting in
greater incidence of
early intervention with
better disease
prevention in overall
population
Increased wellness in
chronically ill
Strength of
Availability of
Net
LeverageEvidence re
Resources
Financial
able
Health Outcomes
that can be
Impact
Resources
(w/references)
Leveraged
Medicaid,
Medigap,
FIDA,
MLTCP,
HRA
DRAFT IN PROGRESS
Population
Health
Objective
Better disease
prevention in
overall
populationincreased
wellness in the
chronically ill
Coverage of
medical needs
Social Impact
Reduction in
number of people
who are unable to
obtain, or delay
obtaining health
care-healthier
population.
Lower healthcare
costs
Greater number of
individuals with
specific source of
ongoing care
Less avoidable
visits to ER and
hospitals.
Less use of hospital
as pcp.
Identifiable
CoBeneficiaries
(outside VBP
modality)
29
Disparities in Access to Appropriate Transportation
Standard
Metric
(yes/no)*
Interventions
Community Based
Case Management
Home Care
Social and Adult
Medical Day Care
Housing with
Services
Intervention
Cost
Health Outcome
Increased ability to
access to healthcare
services, socialization
activities, employment,
education, food and
other activities-greater
sense of independence,
decreased stress, better
disease prevention and
management of chronic
illness
Net
Financial
Impact
Strength of
Evidence re
Health
Outcomes
(w/references)
Leverageable
Resources
Availability of
Resources
that can be
Leveraged
DOT, MTA,
Access a
Ride,
Ambulette
services
DRAFT IN PROGRESS
Population
Health
Objective
Better disease
prevention in
overall
populationincreased
wellness in the
chronically ill
Educated
population with
greater ability
to avail itself of
available
opportunities
Accessibility to
medical
appointments
Social Impact
Reduction in number of
people who are unable to
obtain, or delay obtaining
health care-healthier
population
Decreased
unemployment
Greater number of
individuals able to access
educational opportunities
Decreased stress
Increased opportunities
for socialization
More preventative
interventions and better
medication and health
management
Identifiable
CoBeneficiaries
(outside VBP
modality)
30
Lack of Socialization
Standard
Metric
(yes/no)*
Interventions
Client Centered
Technology
Senior Centers
Faith Based
Meeting
Intervention
Cost
Health Outcome
Minimize feelings of
social isolation and the
cognitive, behavioral,
and physiological
consequences of
loneliness,
Decrease depression
Net
Financial
Impact
Strength of
Evidence re
LeverageHealth
able
Outcomes
Resources
(w/references)
VSC, Friendly
visitor
programs,
care giver
support,
senior centers,
SADS
Availability
of
Resources
that can be
Leveraged
DRAFT IN PROGRESS
Population Health
Objective
Minimize feelings of
social isolation and
the cognitive,
behavioral, and
physiological
consequences of
loneliness
Decresae depression
Icreased mortality risk
Increase in overall
well being
Social Impact
Healthier, happier
population
Lower incidence of
mental illness, criminal
behavior
Reduction in
depression, stress and
anxiety
Identifiable
CoBeneficiaries
(outside VBP
modality)
31
Disparities in Access to Entitlements, Benefits, and
Other supports for Independent Living (e.g.,
Clothing, Phone Bill, A/C Units)
Standard
Metric
(yes/no)*
Interventions
Community
Based Case
Management
Care
Transitions
Care
Coordination
Intervention
Cost
Health Outcome
Net
Financial
Impact
Strength of
Availability
of
Evidence re
LeveragePopulation Health
Resources
Health
able
Objective
Outcomes
Resources that can be
Leveraged
(w/references)
ECAP
Increase equivalent
Supplemental
household income
Minimize adverse
Grants
health effects of
stress
DRAFT IN PROGRESS
Social Impact
Decrease in poverty
Increase in population
well-being
Allows patient to not
have to choose
between medication,
rent and food over
clothing for example.
Identifiable
CoBeneficiaries
(outside VBP
modality)
32
Social, Family and Community
-Criminal Justice Involvement
-Isolation and Lack of Family Support
-Trauma
33
Criminal Justice Involvement
Standard Metric (yes/no)*
Interventions
Ongoing support during
incarceration that
includes both pre-and
post-reentry services.
Yes
Functional Family
http://www.wsipp.wa.gov/Bene Therapy in state
fitCost?programSearch=Functi institutions, youth on
onal+Family+Therapy;
probation and Parole
http://www.nrepp.samhsa.gov/ with quality assurance
ViewIntervention.aspx?id=372; (http://www.wsipp.wa.go
http://www.cdc.gov/violencepre v/BenefitCost?programS
vention/youthviolence/pdf/oppo earch=Functional+Famil
rtunities-for-action.pdf
y+Therapy)
Intervention
Cost
Health
Outcome
Costs:
(($3,405) or
for parole
($4,538))
and benefits:
($34,379 or
for parole
$10,168)
This program
has been
shown to
significantly
reduce
delinquency,
violence, and
violent crime
and sustain
improvement
s over time
Identifiable
Availability of
Strength of
Population
CoLeverageNet Financial Evidence re Health
Resources
Social
Beneficiaries
Health
able
Impact
that can be
Impact
Outcomes
(outside VBP
Objective
Resources
Leveraged
(w/references)
modality)
Yes
Multi-systemic Therapy Costs:((7,68
Yes
(http://www.wsipp.wa.gov/Ben (http://www.nrepp.samhs 9) and
a.gov/SearchResultsNe benefits
efitCost?topicId=1)
w.aspx?s=b&q=multisyst $15,611)
emic%20therapy)
Benefit: cost
$11.19 to
$3.24;
Chances
benefits will
exceed costs:
99% to 75%
Very strong
(considered
evidence-based in
SAMHSA's NREPP
database, and by
CDC)
Benefit:cost
$3.03;
Chances
benefits will
exceed costs:
88%
Very strong
(considered
evidence-based in
SAMHSA's NREPP
database, and by
CDC)
DRAFT IN PROGRESS
34
Criminal Justice Involvement (Cont’d)
Identifiable
Availability of
Strength of
Population
CoLeverageIntervention
Health
Net Financial Evidence re Health
Resources
Social
Beneficiaries
Standard Metric (yes/no)*
Interventions
Health
able
Cost
Outcome
Impact
that can be
Impact
Outcomes
(outside VBP
Objective
Resources
Leveraged
(w/references)
modality)
Yes
Costs:
Benefit: cost
Very strong
Multi-dimensional
http://www.nrepp.samhsa.gov Treatment Foster Care
((8,230) and
$2.11 Chances (considered
/ViewIntervention.aspx?id=48 (http://www.nrepp.samhs benefits:
benefits will
evidence-based in
and
exceed costs:
a.gov/ViewIntervention.as $9,126)
SAMHSA's NREPP
http://www.wsipp.wa.gov/Ben px?id=48)
65%
database, and by
efitCost/Program/20
CDC)
Parent-Child Interaction
Therapy
Yes
(http://www.nrepp.samhsa.go
v/ViewIntervention.aspx?id=3
25)
Victim offender restitution (Cost:$605; Crime/
services
benefits:
Delinquency
(http://www.nrepp.samhs $3,271)
a.gov/ViewIntervention.as
px?id=325) and victim
offender mediation
services
(http://www.wsipp.wa.gov/
BenefitCost/Program/45)
not sure if this is the
same as restitution?
Chances
benefits will
exceed costs
78%
DRAFT IN PROGRESS
35
Isolation and Lack of Family Support
Standard Metric
(yes/no)*
Yes
(http://www.nrepp.s
amhsa.gov/ViewInt
ervention.aspx?id=
1)
Identifiable
Strength of
Availability
Coof
Evidence re LeverageIntervention
Health
Net Financial
Population Health
Beneficiarie
Interventions
Resources
Social Impact
Health
able
Cost
Outcome
Impact
Objective
s (outside
Outcomes Resources that can be
VBP
Leveraged
(w/references)
modality)
Triple P Level 4 - Group
Costs: $ 550; Triple P has
Schools, Varies
1: Decrease
Increase
Jails,
Benefit: cost Very strong
social
negative and
Triple P has 5 Levels (ages Benefits:
been shown to NA Chances (considered
social
Schools,
0-55yrs.)
disruptive child
Employers,
1565;
cohesion;
reduce costs benefits will
evidence-based service
(http://www.wsipp.wa.gov/B
behaviors; 2:
Healthcare
agencies
Better
associated
exceed costs: in SAMHSA's
enefitCost?programSearch
Decrease negative educational
for
with conduct 100%
NREPP
recruitment
parenting practices outcomes;
=Triple+P) and
disorder, child
database)
and
as a risk factor for Decrease
(http://www.nrepp.samhsa.
abuse and outsupport
later child behavior violence
gov/ViewIntervention.aspx?
of-home
problems; 3:
id=1)
placement
Increase positive
parenting practices
as a protective
factor for later child
behavior problems
DRAFT IN PROGRESS
36
Isolation and Lack of Family Support (Cont’d)
Strength of
Availability
Evidence re Leverageof
Intervention
Standard Metric (yes/no)* Interventions
Health
able
Resources
Cost
Outcomes
Resources that can be
(w/references)
Leveraged
Yes
Costs: ($ 149); Triple P has been Benefit:
Very strong
Schools,
Varies
Triple P
Benefits: 1278; shown to reduce Cost is
(http://www.nrepp.samhsa.go Parenting
(considered
social service
agencies for
v/ViewIntervention.aspx?id=1) (System)
costs associated $9.58;
evidencerecruitment
with conduct
Chances based in
benefits will SAMHSA's
and support
disorder, child
abuse and out-of- exceed
NREPP
home placement costs: 58% database)
Net
Health Outcome Financial
Impact
DRAFT IN PROGRESS
Population Health
Objective
1: Decrease
negative and
disruptive child
behaviors; 2:
Decrease negative
parenting practices
as a risk factor for
later child behavior
problems; 3:
Increase positive
parenting practices
as a protective
factor for later child
behavior problems
Social
Impact
Increase
social
cohesion;
Better
educational
outcomes;
Decrease
violence
Identifiable
CoBeneficiaries
(outside VBP
modality)
Jails,
Schools,
Employers,
Healthcare
37
Isolation and Lack of Family Support (Cont’d)
Standard Metric
(yes/no)*
Interventions
Intervention
Cost
Yes
Triple P Parenting- Costs: ($ 976);
(http://www.nrepp.sa Level 4 Individual Benefits: 629;
mhsa.gov/ViewInter
vention.aspx?id=1)
Availability
Strength of
Net
Leverageof
Evidence re
Health Outcome Financial
able
Resources
Health Outcomes
Impact
Resources that can be
(w/references)
Leveraged
Triple P has been Benefit:
Very strong
Schools,
Varies
shown to reduce
Cost is
(considered
social
costs associated
$1.64;
evidence-based in service
with conduct
Chances
SAMHSA's
agencies
disorder, child
benefits will NREPP database) for
abuse and out-of- exceed
recruitment
home placement
costs: 64%
and support
DRAFT IN PROGRESS
Population Health
Objective
1: Decrease
negative and
disruptive child
behaviors; 2:
Decrease negative
parenting practices
as a risk factor for
later child behavior
problems; 3:
Increase positive
parenting practices
as a protective
factor for later child
behavior problems
Social
Impact
Increase
social
cohesion;
Better
educational
outcomes;
Decrease
violence
Identifiable
CoBeneficiaries
(outside VBP
modality)
Jails,
Schools,
Employers,
Healthcare
38
Isolation and Lack of Family Support (Cont’d)
Standard Metric
(yes/no)*
Yes
(http://www.nrepp.sam
hsa.gov/ViewInterventi
on.aspx?id=213)
Interventions
Other Behavioral
Parent Training
(BPT) for children
with disruptive
behavior disorders
(there are several)
Strength of
Evidence re
Health
Intervention Cost
Health
Outcome
Outcomes
(w/references)
Cost: 110;
Reduce
Benefit: cost Very strong
Benefits: $1,276 conduct
NA Chances (considered
disorder, child benefits will evidence-based
abuse, trauma- exceed
in SAMHSA's
informed
costs: 89% NREPP
database see:
http://www.nrepp
.samhsa.gov/Vie
wIntervention.as
px?id=213 )
Net
Financial
Impact
Availability
of
LeverageResources
able
Resources that can be
Leveraged
Schools,
social
service
agencies
for
recruitment
and support
DRAFT IN PROGRESS
Population Health
Objective
Family
relationships,
mental health,
social functioning
Social
Impact
Increase
social
cohesion;
Better
educational
outcomes;
Decrease
violence
Identifiable
CoBeneficiaries
(outside VBP
modality)
Jails,
Schools,
Employers,
Healthcare
39
Isolation and Lack of Family Support (Cont’d)
Standard Metric (yes/no)*
Yes
(http://www.nrepp.samhsa.go
v/ViewIntervention.aspx?id=8
+B9:L10+B9:H108)
Interventions
Intervention
Cost
Nurse Family
Cost: ($9,993);
Partnership for low- Benefits:
income children
$18,885
http://www.wsipp.wa
.gov/BenefitCost/Pr
ogram/35
Strength of
Availability
Net
Evidence re Leverageof
Population
Health Outcome Financial
Health
Resources
able
Health Objective
Impact
Outcomes Resources that can be
Leveraged
(w/references)
Primary outcomes Benefit: Very strong
affected: Crime, Cost
(considered
Test scores, Child $2.89
evidenceabuse and
Chances based in
neglect, K-12
benefits SAMHSA's
NREPP
grade repetition, will
K-12 special
exceed database
(http://www.nre
education,
costs:
pp.samhsa.gov
Disruptive
75%
/ViewInterventi
behavior disorder
on.aspx?id=88)
symptoms,
and
Internalizing
Community
symptoms
Guide
(http://www.cdc
.gov/ViolenceP
revention/child
maltreatment/p
revention.html)
DRAFT IN PROGRESS
Social
Impact
Identifiable
CoBeneficiaries
(outside VBP
modality)
40
Isolation and Lack of Family Support (Cont’d)
Standard Metric (yes/no)*
Yes
http://www.wsipp.wa.gov/Ben
efitCost/Program/119
Yes
(http://www.nrepp.samhsa.go
v/ViewIntervention.aspx?id=3
72)
Availability
Identifiable
Strength of
LeveragePopulation
of
CoIntervention
Net Financial Evidence re Health
Social
Interventions
Health Outcome
able
Health
Beneficiaries
Resources
Cost
Impact
Outcomes
Impact
Resources that can be Objective
(outside VBP
(w/references)
modality)
Leveraged
Healthy Families
Cost: ($4,767): Primary outcomes Benefit: Cost Promising (not listed
$1.06
America
in SAMHSA's
Benefits: $271 affected: Major
Chances
http://www.wsipp.wa
NREPP or
depressive
benefits will
.gov/BenefitCost/Pr
Community guide)
disorder, Illicit
exceed costs
ogram/119
drug abuse or
54%
dependence
symptoms,
Problem alcohol
use, Low birth
weight births
Functional Family Costs and
substance abuse Not available Conflicting.
Therapy for children benefits not
and delinquency, as WSIPP
SAMHSA NREPP
says no
in the welfare
available see:
HIV risk
lists as evidencesystem
http://www.nrepp behaviors, and/or rigorous
based; WSIPP
evaluation for states that rigorous
.samhsa.gov/Vie depression (or
wIntervention.as other behavioral outcome of
evaluation is not
interest(see: available.
px?id=372
and mood
disturbances) and http://www.wsi
pp.wa.gov/Ben
their families
efitCost?progr
amSearch=Fu
nctional+Famil
y+Therapy)
DRAFT IN PROGRESS
41
Isolation and Lack of Family Support (Cont’d)
Standard Metric
(yes/no)*
Interventions
Yes
Parent-Child Interaction Therapy
(http://www.wsipp.wa.
gov/BenefitCost?prog
ramSearch=+G21+B2
1:G21+G21+B21:G21
+B21:H21+B21:G21+
B21:F21
Yes
Conditional Cash Transfer (still
http://www.mdrc.org/p experimental)
ublication/conditional- http://www.mdrc.org/publication/con
cash-transfers-new- ditional-cash-transfers-new-yorkyork-city
city
Intervention
Cost
Health Outcome
Costs: (($1,613) Family/relationships,
and benefits: $ Mental health, Social
functioning,
37,552))
http://www.wsipp Trauma/injuries,
.wa.gov/BenefitC Physical aggression
ost?programSea and violence-related
rch=parent+child behavior
+interaction+ther
apy
Still experimental
Strength of
Evidence re LeverageHealth
able
Outcomes Resources
(w/references)
Benefit:
Very Strong
Cost
SAMHSA
$24.28
NREPP and
Chances CDC list as
benefits
evidencewill exceed based
costs
100%
Net
Financial
Impact
DRAFT IN PROGRESS
Identifiable
Availability
Population
Coof
Social
Health
Beneficiaries
Resources
Impact
(outside VBP
that can be Objective
modality)
Leveraged
42
Isolation and Lack of Family Support (Cont’d)
Strength of
Net
Evidence re LeverageStandard Metric
Intervention
Interventions
Health Outcome Financial
Health
able
(yes/no)*
Cost
Impact
Outcomes Resources
(w/references)
Yes
NA (often Often
Quality afterschool program that follow Not found
drug use, positive
http://www.expanding the SAFE framework (sequenced stepevaluated evaluated as
social behaviors,
learning.org/docs/Dur by-step training approach (S),
reduction in problem as part of part of a
lak&Weissberg_Final. emphasized active forms of learning by
a
package
behaviors, school
pdf
package)
having youth
bonding, school
practice new skills (A), focused specific
grades, selftime and attention on skill development
perceptions,
(F) Afterschool Programs That Follow
academic
Evidence-Based Practices to Promote
achievements
Social and Emotional Development Are
Effective (E) and were explicit in defining
the skills they were attempting to
promote
Yes
School-based and community-based
Crime, High school Chances
Wide
Mentoring programs for students
graduation, Illicit drug benefits
variations
(http://www.nrepp.samhsa.gov/SearchR ($75 use before end of
will
esultsNew.aspx?s=b&q=mentoring and $25,821)
middle school, Grade exceed
http://www.wsipp.wa.gov/BenefitCost?pr
point average,
costs 60ogramSearch=mentoring)
School attendance, 70%
Office discipline
referrals, Test scores
DRAFT IN PROGRESS
Availability
Identifiable
of
Population
CoSocial
Resources
Health
Beneficiaries
Impact
that can be Objective
(outside VBP
Leveraged
modality)
43
Isolation and Lack of Family Support (Cont’d)
Standard Metric
(yes/no)*
Interventions
Yes
Empowerment of vulnerable
(http://www.euro.who. populations. Empowerment
int/__data/assets/pdf is recognized both as an
_file/0010/74656/E88 outcome by itself, and as an
086.pdf)
intermediate step to longterm health status and
disparity outcomes
Intervention
Cost
Health Outcome
Within the first pathway, a
range of outcomes have
been identified on multiple
levels and domains:
psychological,
organizational, and
community-levels; and
within household/family,
economic, political,
programs and services
(such as health, water
systems, education), and
legal spheres. Only a few
researchers have used
designs resulting in
evidence ranked as strong
in the traditional evidence
grading systems
Strength of
Evidence re LeverageNet Financial
Health
able
Impact
Outcomes Resources
(w/references)
Yet there is
Very strong
evidence based
on multi-level
research
designs that
empowering
initiatives can
lead to health
outcomes and
that
empowerment is
a viable public
health strategy
DRAFT IN PROGRESS
Availability
Identifiable
of
Population
CoSocial
Resources
Health
Beneficiaries
Impact
that can be Objective
(outside VBP
modality)
Leveraged
44
Trauma (e.g., Domestic Abuse, Rape)
Standard Metric
(yes/no)*
Interventions
Intervention
Cost
Yes
Cognitive Behavioral
Cost: 332
(http://www.wsipp.wa. Therapy (CBT)-based
Benefits:
gov/BenefitCost?prog models for child trauma
6501
ramSearch=trauma) (http://www.wsipp.wa.gov/Be
nefitCost/Program/155)
Health Outcome
Building resiliency
Yes
Cognitive Behavioral
Cost:($351) Building resiliency
(http://www.wsipp.wa. Therapy (CBT)-based
Benefits:
gov/BenefitCost?prog models for
37,004
ramSearch=trauma) PTSD(http://www.wsipp.wa.g
ov/BenefitCost/Program/155)
Strength of
Evidence re LeverageHealth
able
Outcomes Resources
(w/references)
Benefit: cost Very strong
Schools,
NA
social
Chances
service
benefits will
agencies for
exceed
recruitment
costs: 98%
and support
Identifiable
CoBeneficiaries
(outside VBP
modality)
Jails,
Schools,
Employers,
Healthcare
Benefit: cost Very strong
NA
Chances
benefits will
exceed
costs: 100%
Jails,
Schools,
Employers,
Healthcare
Net
Financial
Impact
DRAFT IN PROGRESS
Availability
of
Populatio
Social
Resources n Health
Impact
that can be Objective
Leveraged
Schools, Increase
social
social
service
cohesion;
agencies Better
for
educational
recruitmen outcomes;
t and
Decrease
support
violence
Schools,
Schools, Increase
social
social
social
service
service
cohesion;
agencies for
agencies Better
recruitment
for
educational
and support
recruitmen outcomes;
t and
Decrease
support
violence
45
Trauma (e.g., Domestic Abuse, Rape) (Cont’d)
Standard Metric
(yes/no)*
Interventions
Yes
Parent-Child Interaction
(http://www.wsipp.wa. Therapy
gov/BenefitCost?prog
ramSearch=)
Yes
Strength of
Evidence re LeverageIntervention
Net Financial
Health Outcome
Health
able
Cost
Impact
Outcomes Resources
(w/references)
Family/relationships,
Costs:
Benefit: Cost Very Strong
(($1,613) and Mental health, Social
$24.28
SAMHSA
functioning,
benefits: $
Chances
NREPP and
Trauma/injuries, Physical benefits will
37,552))
CDC list as
http://www.w aggression and violence- exceed costs evidencesipp.wa.gov/ related behavior
100%
based
BenefitCost?
programSear
ch=parent+c
hild+interacti
on+therapy
Screening for trauma
(http://www.integration.samh
sa.gov/clinicalpractice/SAMSA_TIP_Traum
a.pdf (Appendix D and p. 104
and
http://www.integration.samhs
a.gov/clinicalpractice/screening-tools )
and (ACES and Resilience
Score:
http://acestoohigh.com/gotyour-ace-score/)
DRAFT IN PROGRESS
Availability
Identifiable
of
Population
CoSocial
Resources Health
Beneficiaries
Impact
that can be Objective
(outside VBP
Leveraged
modality)
46
Trauma (e.g., Domestic Abuse, Rape) (Cont’d)
Standard Metric
(yes/no)*
Yes
Interventions
Intervention
Cost
Health Outcome
Net
Financial
Impact
Strength of
Availability
Identifiable
of
Evidence re
Population
CoLeverageSocial
Resources Health
Beneficiaries
Health
able
Impact
(outside VBP
Outcomes
Resources that can be Objective
Leveraged
modality)
(w/references)
Example of collective healing
program: Truth and
Reconciliation/restorative
justice process for mass
trauma. The truth and
reconciliation process seeks
to heal relations between
opposing sides by
uncovering all pertinent facts,
distinguishing truth from lies,
and allowing for
acknowledgement,
appropriate public mourning,
forgiveness and healing.
(http://www.greensborotrc.or
g/truth_reconciliation.php)
DRAFT IN PROGRESS
47
Neighborhood and Environment
-Poor Air Quality
-Physical Barriers in the Home
48
Poor Air Quality
Standard
Metric
(yes/no)*
Interventions
Intervention
Cost
Health Outcome
Identifiable
Strength of
Availability of
Net
LeveragePopulation
CoEvidence re
Resources that
Financial
able
Health
Social Impact Beneficiaries
Health Outcomes
can be
Impact
(outside VBP
Resources
Objective
(w/references)
Leveraged
modality)
Not started
Physical Barriers in the Home
Standard
Metric
(yes/no)*
Interventions
Intervention
Cost
Health Outcome
Identifiable
Strength of
Availability of
Net
LeveragePopulation
CoEvidence re
Resources that
Financial
able
Health
Social Impact Beneficiaries
Health Outcomes
can be
Impact
(outside VBP
Resources
Objective
(w/references)
Leveraged
modality)
Not started
49
Remaining Roadmap Questions
for Discussion
50
Guidelines for Providers and the State
ƒ How can we measure provider performance related to how they impact SDH?
ƒ How should the state incentivize provider payments?
ƒ Other questions/ideas?
51
Housing Determinants
ƒ Where can money be leveraged from?
ƒ Other questions/ideas?
52
Capturing Savings Across Public Spending
ƒ What public programs would incur savings with SDH interventions?
ƒ How can these savings be measured?
ƒ Other questions/ideas?
53
Reminder: Meeting Schedule and Logistics
Meeting #
Confirmed
Date
Time
Location
Meeting 1 - SDH
7/30/2015
1:00-4:00pm
Albany – HANYS
Meeting 2 - SDH
8/19/2015
1:00-4:00pm
Albany School of Public
Health – Massry Center
Meeting 3 - SDH
9/9/2015
1:00-4:00pm
90 Chuch St., NYC
Meeting 4 - CBO
10/15/2015
12:00pm-3:00pm
NYC, TBD
Meeting 5 - CBO
11/17/2015
1:00pm-4:00pm
90 Church St. NYC
Meeting 6 - CBO
12/16/2015
1:00pm-4:00pm
Albany - HANYS
Subcommittee Co-chairs
Charles King [email protected]
Kate Breslin [email protected]