The Intersection of Health, Housing, and Wealth: Lifting up Low to Moderate Income Families and Communities in Los Angeles County Peter Long, Ph.D. President and CEO October 4, 2017

key take away messages California health care is in a dynamic phase Federal policy environment and funding are uncertain Proposed delegation of authority and resources to state and local levels Care and payment models are changing Increasing collaboration between health care and other sectors Infrastructure is not in place to support population health efforts blueshieldcafoundation.org

blue shield of california foundation We believe all Californians can be healthy and safe Our mission: Improve the lives of all Californians, particularly the underserved, by making health care accessible, effective, and affordable, and by ending domestic violence. About us: Total Grantmaking since 2002: Over $390 million 2015 Grantmaking: $30.8 million, 461 grants Independent Board: 9 Trustees, 5 from Blue Shield of California Total Number of Staff: 24 Source of Funding: Annual contributions from Blue Shield of California Layout: Title Only blueshieldcafoundation.org

U.S. Health Delivery System Transformation Path where are we now? U.S. Health Delivery System Transformation Path 1.0 2.0 3.0 Sick Care System Coordinated Health Care System Community Integrated Health System Era 1900s-1950s 1950s-present 2000 onward Health Is Neal Halfon, Peter Long, Debbie I. Chang, James Hester, Moira Inkelas and Anthony Rogers. (2014). Adapted from a Center for Medicare and Medicaid Innovation Figure. Absence of acute disease Reduction of chronic disease Creating capacities to achieve goals, satisfy needs Care Goal Improve life expectancy Reduce disability Optimize health Halfon et al., 2014

health transformation framework 1.0 2.0 3.0 SYSTEM DESIGN Health service providers, operating separately Team-based care within health Community integrated services, health care as one component CARE MODEL Little coordination between in/out patient care, episodic treatment Chronic condition management, patient-centered care coordination Health, psychosocial, and wellness care integrated across the life course DOMINANT PAYMENT APPROACH Fee-for-service Value-based health payments Population-based global budgets, linked to multi-sector financial impact APPROACH TO QUALITY Variable, low transparency Consistent, standardize processes and outcomes Continuous learning and quality improvement BENEFICIARY LENS Individual Patient and family Subpopulations and communities, equity- oriented Halfon et al., 2014. Adapted from Figure 2.

principles & design strategies 3.0 Community Empowerment and Engagement Community Integration Functions Information and Measurement Financing Approaches

behavioral health integration

integration beyond health care Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE)

California whole person care pilots LA Housing for Health Program

bringing 3.0 design elements together in communities California Accountable Communities for Health Initiative (CACHI) Imperial County Public Health Department, Imperial County Merced County Department of Public Health, Merced County Be There San Diego/University of California, San Diego, San Diego County Dignity Health/St. Joseph’s Medical Center, San Joaquin County Santa Clara County Public Health Department, Santa Clara County Sonoma County Department of Health Services, Sonoma County 44 proposals received this year – 50% more than expected Address a wide range of community identified health issues: diabetes, cardiovascular disease, multiple chronic diseases, TRAUMA, BEHAVIORAL HEALTH, prenatal care, advance care planning 6 sites will be funded – announcement coming June 10th

systemic barriers to health innovations 3.0 Unsupportive policy and payment framework Uncertainty with evidence base Different definitions of success Limited patient, and community engagement Under-achieving implementation science

2017-2021 Strategic Plan: Further forward. DV Health Health + DV Guides Informs Secures gains Protects vulnerable populations Act Now Big Ideas Prioritizes Disrupt status quo Promote equity Produce impact Prevention in Practice Change Practice Builds Capacity Willing Partners Change Environment Learn Sustain Spread Population Health Ecosystem Financing Community Engagement Shared Outcomes Leadership Data Policy blueshieldcafoundation.org

some unanswered questions What does success look like in a 3.0 health system? What are the core elements of the population health ecosystem? How will we move from health 2.0 to 3.0? Layout: One-Column Content blueshieldcafoundation.org

thank you web: BlueShieldCAFoundation.org @PeterLongBSCF Facebook.com/blueshieldcafoundation Youtube.com/user/BlueShieldCAFdn