A Connections Checklist: Bringing Health Care and Communities Together

Dec 10, 2013, 1:34 PM, Posted by Hilary Heishman

Cure Violence Community meeting

The conversation is nearly everywhere I go for work lately. More than cost trends, or accountable care organizations, I hear people in both public health and health care circles talking about how we need to be better connected.

Across a variety of health roles, many people are embracing the belief that individuals and the communities we live in will be better off—regarding health outcomes, health care cost, health disparities, corporate productivity, individual quality of life, and so forth—if health care providers, the public health system, and social services are better connected to each other and to the communities in which patients live.

Fortunately, it’s not all talk. In communities across the nation people are trying their best to connect systems to improve the overall health of those who live there, driven by a combination of compassion, pragmatism, pressure, policies, and overall gestalt.

Pinned to the wall next to my desk I keep a list of what I consider to be the components of a connected system for health, a sort of checklist. I pulled it together from a bunch of sources so when I learn of a community that might be a good example, I have a structured way to think about ‘how connected are they?’ Here it is:

Important components of a community or state with connected systems for health:

  • Widely agreed-upon vision and goals for improved health outcomes and quality of life (a north star)
  • Multi-stakeholder, multi-sectoral collaboration
    • with an “integrator” organization
    • with individuals who are boundary-spanning leaders
    • with real buy-in, actions, risk, and benefits for participating groups and individuals
    • with clear decision-making rules and actors
  • An agreed-upon plan of action with priorities, a theory of change, and indicators, such as a community health improvement plan (the roadmap)
  • An entity that has authority to be a point of accountability for achieving goals and for how funds are spent. The integrator could be the point of accountability, but may not be.
  • A financing system for health (flow of money)
    • Paying for or otherwise financially incentivizing activities and environments that lead to improved health outcomes, such as through global health budgeting, bundles and other payment reforms, community benefits spending, health insurance co-ops profits, trusts, social impact bonds
    • Tying funding to metrics, which are reported to the primary point of accountability
  • Data, metrics, information systems, and appropriate data transparency (flow of information)
    • Including tracking, analyzing, and using data about health care, public health, and the community;
    • Publicly reporting data about health, quality of services, and how much services cost
    • Linking and layering data systems or databases
  • Communication and learning among organizations within the system as well as with other communities in both local and broad networks.
  • Community member education, engagement, and involvement  (buy-in and demand)
  • Appropriately defined roles, relationships among roles, and training for participants
  • Quality improvement and performance monitoring built in for continuous learning and improvement (feedback loops)
  • Appropriate non-financial incentives, standards, rules, and regulations (boundaries)
  • Freedom, power, and ability for participating groups to self-organize, compete, and be creative, to enable them to innovate and make improvements
  • Social and cultural encouragement and reinforcement

My list aside, over the last year we all have had the opportunity to learn from great, more thorough descriptions of what connected community health systems could be like: Accountable Care Communities, Accountable Health Communities, Community Centered Health Homes, Medical Neighborhoods, Lifelong Health Systems, and others. I also look for what we can learn from examples of care transition programs, super-utilizer programs, patient-centered medical homes, integrated behavioral health programs, and community health collaborations.

A variety of organizations and individuals are buzzing with ideas or plans to help. In recent months I have attended meetings with groups like Communities Joined in Action, the Center for Health Care Strategies, America’s Essential Hospitals, Stakeholder Health, American Public Health Association, the National Network of Public Health Institutes, ReThink Health, and an RWJF initiative, Aligning Forces for Quality, in which connecting community or state systems for health is a theme. I have also been keeping track of what groups like the Institute of Medicine, Trust for America’s Health and National Governors Association are doing.

I listen to people who have more experience than I do. John Lumpkin, a senior vice president at RWJF, is happy to remind me of related conversations he and others were having well over a decade ago. It means we have past work to learn from. I think it also means we have a duty to take advantage of the opportunity this period of change in public health and health care presents us.

This is an exciting, ripe time.

Hilary Heishman is a program officer for RWJF's  Health Care Group.