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Local Governments Help Lead the Way to HHS Convergence (Industry Perspective)

HHS convergence is a coordinated, agile and common sense approach that contributes to healthier residents, healthier communities and a healthier nation.

Good health does not happen in isolation. Social and economic factors such as education, healthy food, housing and income — often referred to as social determinants — have a significant influence on health. Effectively addressing health-care challenges, including improving access, increasing awareness, and preventing and lowering costs, requires better convergence of health and human services systems. 

Health and human services convergence is wholly coordinated and data-driven service delivery that empowers individuals and occurs across health, social services and community-based providers in both the public and private sectors. This coordinated, agile and common sense approach contributes to healthier residents, healthier communities and, at scale, a healthier nation. The impacts are profound: system changing, policy changing and life changing.

Leading a groundswell of change

Cities and counties are in an excellent position to drive health and human services convergence. For example, consider counties’ unique ability as policymakers to incorporate social determinants of health into their approaches to achieve better health outcomes:

  • Local safety nets. Counties deliver individual and population-based services such as indigent care; behavioral health; nutrition counseling; disease surveillance, screening and treatment; violence prevention; employment services; and residential services.
  • Significant investment. Counties invest $69.7 billion in health and $53.8 billion in public welfare  (e.g., housing, public assistance, nutrition assistance, etc.) to provide these services via health and human services departments and health-care facilities. 
  • Multiple touchpoints. Counties often serve the same individuals and families through various agencies.
  • Services coordination. Coordinating comprehensive services delivery in a data-driven manner is critical to counties, as it allows them to address multiple needs in a more efficient, effective and holistic manner to better serve people. 

Making a real impact on health outcomes

Data indicate that social determinants of health account for as much as 40 percent of poor health outcomes. These determinants also influence health behaviors (e.g., tobacco use, substance use, physical activity), which also impact health outcomes.    

By addressing the socioeconomic factors and the context in which individuals make default decisions, interventions are likely to have the greatest impact on a population. For example, Plumas County, Calif., a rural county with a population of approximately 20,000, has engaged the community at all levels with its 20,000 Lives Initiative across its mountainous terrain. 

For the past several years, Plumas County has partnered with tribal organizations, the health-care system, community organizations and local businesses to obtain data to better address the community’s needs. The Plumas County Public Health Agency also collaborated with the school district to ensure that families of children receiving free school lunches are enrolled in Medicaid and social service programs, if they are eligible. By using socioeconomic data and coordinating efforts with the education system, the county has addressed access to care for both children and adults. 

Health and human services convergence is a complex undertaking fueled by the need for coordination, innovation, leadership and inspiration. Add a healthy dose of strong governance, and counties can drive progress through incremental success. 

The National Association of Counties’ (NACo) Healthy Counties Initiative helps counties share best practices, whether they are urban or rural, regardless of their available capital and human resources. Counties are linked by their growing understanding that the data reveal a compelling story about the need to break through traditional silos that commonly isolate health and human services delivery from one another. The Healthy Counties Initiative launched in 2011 to enhance public-private partnerships in local health-care delivery, improve individual and community health, and assist counties in implementing federal health reform. 

As counties independently demonstrate the benefits of addressing the social determinants of health while coordinating services, broad trends have emerged that characterize the dynamics of health and human services convergence today.

1. Addressing the social determinants of health at the local level is a movement spreading across the nation. 

As noted earlier, convergence is taking root locally in diverse areas, driven by cost pressures and the hyper-transformation triggered by the Affordable Care Act. From Montgomery County, Md., to San Diego County, Calif., counties are coordinating health and human services to better target the needs of their population to drive improved outcomes and reduce costs.

Montgomery County has created a “no wrong door” approach, which enables its 1 million residents to access any and all available services based on need, regardless of the program door through which they enter. A multidisciplinary team and integrated technology system facilitate a multipronged approach to prevent and reduce poor health outcomes and reduce the number of individuals entering the foster care system, homelessness and/or unemployment. 

The Miami-Dade County, Fla., Parks and Recreation Department and local health department have employed similar principles in making parks, educational programs and facilities accessible to residents regardless of age, income, ability or geographic location. This strengthens the county’s social fabric by improving community design and creating sustainable environmental changes to reduce obesity, increase physical activity and improve nutrition.  

2. Convergence is about today, not just a hope for tomorrow. 

Perfection is often the enemy of progress and incremental change. Many of the conditions, tools and solutions needed to achieve stronger convergence already exist and only require the meaningful exchange of institutional knowledge. 

Despite Olmsted County, Minn.’s Department of Community Services overseeing mental health, probation, housing development and all social services for adults and children, the agency realized it was not achieving the best possible outcomes for its 140,000 residents. As Olmstead explored options to integrate behavioral health with all other services and break down silos, it sought guidance from Jefferson County, Colo. Learning from Jefferson County’s success in integrating operations, Olmsted County determined it needed to align its services with those of other county agencies to address the interplay of systems and create a culture of change. For example, Olmsted County integrated the work of its probation officers with that of the children’s mental health staff and youth and family services. This helped the county to realize improved and sustained outcomes while reducing costs.

3. Convergence can be powered by digital disruption. 

The inherent nature of digital technology — widely accessible, data-driven and centered on delivering personalized, relevant experiences to individuals — makes it the natural service delivery platform. 

San Diego County, Calif., has developed a 10-year plan, Live Well San Diego, to help its 3.1 million San Diegans stay healthy, safe and thrive. Part of this incremental plan is to transform the health system from a traditional program-centered model to an integrated person-centered model. The focus is on building an enterprise information exchange to connect 10 data source systems, and enable staff and customers to access their integrated records, make electronic referrals for services, share collaborative case notes and receive alerts and notifications. 

Continuing the momentum

The changing health-care landscape and economic pressures broaden both discussions and actions to identify common sense interventions that cut across the individualized social, behavioral and physical dimensions of life. Ultimately, bending the health-care cost curve will require a sustained effort to achieve the following:

  • Creation of a culture of health that permeates all sectors and levels including prevention, intervention, wellness and treatment strategies.
  • Investment in long-term gain strategies — from tobacco prevention to nutrition education to physical activity and environmental awareness, among many others.  
  • Consensus and clarity around what works through evidence-based methods. 
  • Maximization of technology to drive organizational and health outcomes.
  • Development of strong working relationships among counties and state and federal agencies to ensure that public policy is grounded in operational practice. 
Coordinating the service delivery system through health and human services convergence is a progressive and cost-effective approach. It is one that binds counties and the private sector together in innovative and productive partnerships that use organizations’ existing strengths to address the social determinants of health, and ultimately, prevent them. It is about creating and sustaining healthy and thriving communities for healthy individuals while reducing costs. 

By Jerry Friedman, director of strategic initiatives at Accenture, and Emmanuelle St. Jean, health program manager at the National Association of Counties. A version of this article was previously published in the October 2014 edition of Policy & Practice, the journal of the American Public Human Services Association.