Healthy Communities Initiative

Catalyzing Efforts to Improve the Health and Well-Being of All Georgians

Atlanta, GA

March 14, 2017

The Federal Reserve Bank of Atlanta partnered with Georgia State University’s Georgia Health Policy Center to host an event exploring opportunities to improve collaborations between the health care and community development sectors in Georgia. Participants came from multiple sectors—including government, health care, community development, and philanthropy—and represented both rural and urban communities.

Participants first discussed the key social determinants affecting health in Georgia and metrics that could be used to track these indicators. They ranged from housing instability (measured through rental cost burden) to access to health care (measured by travel time and no-show rates) to child literacy (measured by third-grade reading scores). With this common definition of the social determinants of health, the group discussed successful strategies for breaking down silos and facilitating cooperation across them. Some key strategies that emerged included:

  • Willingness to learn the other sector’s languages, cultures, and systems to develop shared goals
  • Sharing data and collectively interpreting it
  • Changing funder policies, with calls for health insurers to adjust their reimbursement policies and for philanthropies to promote cross-sector engagements through their grant making.

The final session of the meeting discussed ways to improve the state of practice across Georgia. Participants noted the importance of impact mapping—to show how investments in one silo positively have an impact on another—as well as money mapping—showing the flow of funds and allocation of costs in the system today. Furthermore, the group agreed that if a set of shared goals could be articulated, then work could be done to import best practices from across the country. Geographic scale remained an open question, as participants debated the efficacy of developing smaller proof of concepts versus identifying possible statewide projects. Some next steps the group suggested taking included:

  • Consider new funding sources, including impact investing and leveraging anchor institutions
  • Map current health-related players and activities to find strategic areas for future action
  • Quantify the costs and return on investment from specific best practices, to increase support for these programs
  • Share data across organizations as a means to increase collaboration and identify synergies.

Conference Sponsors:

 

9:00 Welcoming remarks and introductions

Karen Leone de Nie, Assistant Vice President, Federal Reserve Bank of Atlanta

Sameera Fazili, Senior Visiting CED Adviser, Federal Reserve Bank of Atlanta

9:15 Social Determinants of Health in Georgia

Which social determinants of health (SDOH) are participants actively working on, and which SDOH do they think deserve more attention? What are ways to break down silos and encourage integrated approaches or upstream interventions?

Sameera Fazili

Michelle Rushing, Research Associate, Georgia Health Policy Center

10:00 Improving Our Practice

What are promising approaches being tried locally or nationally that could be scaled or replicated?

Leigh Alderman, Senior Adviser, Georgia Health Policy Center

Sameera Fazili

10:45 Identifying Next Steps

Karen Leone de Nie

Leigh Alderman

11:00 Adjournment

 

The event began with a discussion of what people hoped to achieve. Participants noted:

  • The opportunity to advance work integrating health and community development, especially given the possibility of health care reform (including Medicaid)
  • The high need for this work in the Southeast, given how poor health outcomes continue to be in this region
  • Interest in learning new ideas to bring to their work as (health or community and economic development) practitioners or funders (with specific mentions of impact investing, financial counseling, community engagement, rural health, and new opportunities for collaboration).

The group discussed the social determinants of health (SDOH) as they understood the term and what indicators could be used to measure them. They recognized that indicators and data were critical to any work on community development or health because you are what you measure, and they expressed the desire to share data more cohesively between organizations. The table presents a summary of the key social determinants discussed and the indicators that could be used to measure them. Participants noted that indicators do not always capture the full picture. Two examples given were transportation and childcare. Access to transit does not tell you if health care or jobs are close to transit, it merely tells you if the person has access to transit. In childcare, you may measure outcomes for the child when measuring teacher certifications or tenure, but often miss outcomes for a parent such as a parent’s ability to maintain a job.

Social Determinants of Health and Their Indicators

The table does not capture every SDOH discussed at the meeting, but instead provides a selection of determinants and indicators discussed.

Participants then moved into smaller groups to discuss strategies for breaking silos and facilitating cooperation across sectors to tackle the upstream factors affecting health. They then reported their top recommendations on how to best break barriers to address the social determinants of health. These recommendations included:

  • Willingness to learn the other sectors’ languages, cultures, and systems
  • Access to quality data, willingness to share with one another, and interpret the data together
  • Strong leadership is required to support or push cross-sector partnerships. There were differences of opinion on the level of leadership required—whether it is the state government, civic or local level, and whether that leadership should come from government, philanthropy, or business leader
  • Shared goals, and the importance of a “pitch” highlighting shared and/or mutually reinforcing goals to recruit third-party allies
  • Change in reimbursement policies for community health workers and/or site coordinators to foster stronger one-on-one relationships with patients and families
  • Change in the way money flows in the system to encourage cross-sector work, especially longer-term work, and to improve the quality of health care providers
  • Importance of funders aligning their policies to support the long-term, cross-sector collaborative work necessary to address the upstream work. An example is the Center for Working Families, supported by the Annie E. Casey Foundation, and the work of the East Lake Foundation in East Lake
  • Community quarterbacks (people/organizations who understand the community, what it wants, and its priorities) are needed to help guide new partnerships and new entrants, and to facilitate scaling of projects.

Participants then discussed possible opportunities for improving their work to address social determinants of health. This included impact mapping to demonstrate the benefits that investments in one silo may have for outcomes in another as well as a “money map” to outline the costs in the systems and the flow of funds through it. The goal would be to demonstrate to policymakers, and possibly to funders, that they do not have an either/or choice between, for example, health and education when it is possible to quantify how an educational investment improves health outcomes. Ideally, this mapping will also identify windows of opportunity available, given participants’ time and resources.

The group discussed the importance of identifying shared goals at the start, and using those common goals to identify practices that could be imported from other parts of the country. However, they acknowledged that any efforts needed to be cognizant of larger macro forces that will be shaping the local contexts, including inequality and rural depopulation, and developing resiliency to these macro forces.

Questions were raised on the geographic scale to consider tackling, with debates on whether it was better to take on statewide projects or issues versus focusing on smaller, more circumscribed geographies. Transportation was an example of an issue that affects people statewide, even though the solution sets for rural and urban areas may not look the same. The group also noted that what are considered best practices must be adaptable to the context of a given place. Finally, participants continued to debate what frame was most useful to garner broad-based support for these issues—whether it was health, opportunity, fiscal efficiency, or others—and whether health should be a hub or a spoke in any efforts here.

Areas that participants wanted to explore further and learn more about as a possible follow-up step included:

  • Measurement
    • Share data, including simply knowing other organizations’ target metrics, to enhance collaboration
    • Identify how and where indicators across sectors overlap.
  • Evaluation
    • Track the impact of the Rural Hospital/Health Stabilization project’s activities
    • Track outcomes more rigorously, to be able to tell the story of what has been accomplished.
  • Mapping
    • Develop a list of what’s happening in the health-related space across Georgia to help identify common themes or common levers across geographies and to leverage what’s already happening or already working
    • Co-create a systems map across the state to identify players, work being done, financial flows, and leverage points as well as low-hanging fruit
    • Develop a method for assessing political will at the state and local level to address social determinants of health.
  • Specific Interventions
    • Use impact investing, including program-related investments, to address social determinants of health
    • The role of funders in breaking silos and improving collaboration between sectors
    • Discuss what solutions work in rural communities
    • The role of “anchor institution” strategies in addressing social determinants of health
    • Develop a list of examples of what works elsewhere and could be brought to Georgia, focusing on costs and return on investment, highlighting what the stories have in common, and detailing how collaborators worked to break down barriers.

Participants also recommended the future inclusion of several additional stakeholder groups, including:

  • Public health departments and/or departments of behavioral health and developmental disabilities/behavioral health
  • The United Way
  • Senior-representing organizations, such as the National Church Residences
  • Local elected officials (mayors, county commissioners, Georgia Municipal Association) and public housing authorities

Finally, participants offered some additional next-step recommendations via email, including:

  • Explore whether there is a specific project to implement over the next 12 months
  • Potentially build a resource center/learning network that can be used by others over the next 12 months
  • Have a deeper conversation regarding social impact investing, using a health equity or SDOH lens
  • Invite regional offices from relevant federal agencies to follow-up events.

Appendix A: List of SDOH-Related Efforts

At the meeting, participants discussed the following range of efforts they were engaged in related to SDOH:

Madelyn Adams

Director of Community Benefit

Kaiser Permanente

 

Leigh Alderman

Senior Adviser

Georgia Health Policy Center at Georgia State University

 

Mary Daniels

Executive Director, American College of Physicians Georgia Chapter

American College of Physicians

 

Jimmy Dills

Research Associate

Georgia Health Policy Center at Georgia State University

 

Sameera Fazili

Senior Visiting Adviser, Community and Economic Development

Federal Reserve Bank of Atlanta

 

Laurel Hart

Division Director, Housing Finance & Development

Georgia Department of Community Affairs

 

Harry Heiman

Director of Health Policy, Satcher Health Leadership Institute

Morehouse School of Medicine

 

Kathryn Lawler

Executive Director

Atlanta Regional Collaborative for Health Improvement (ARCHI)

 

Karen Leone de Nie

Assistant Vice President, Community and Economic Development

Federal Reserve Bank of Atlanta

 

Carol Lewis

President

Communities in Schools

 

Gary Nelson

President

Healthcare Georgia Foundation

 

Von Nguyen (Observer)

Acting Associate Director for Policy

Centers for Disease Control and Prevention

 

Jason O’Rouke

Senior Public Policy Director

Georgia Chamber of Commerce

 

Kathy Palumbo

Director of Programs

The Community Foundation

 

Michelle Rushing

Research Associate

Georgia Health Policy Center at Georgia State University

 

Meaghan Shannon-Vlkovic

Vice President and Market Leader, Southeast

Enterprise Community Partners

 

Bernita Smith

Director

Neighborhood Nexus/ARC

 

Courtney Smith

Vice President, Market Manager of Community Development Banking

PNC Bank

 

Shelley Spires

Chief Executive Officer

Albany Area Primary Health Care

 

Chris Thayer

Intern, Community and Economic Development

Federal Reserve Bank of Atlanta

 

Linda Wiant

Division Chief, Medical Assistance Plans

Georgia Department of Community Health