Background: We evaluated the Washington state Practice Transformation Support Hub ("the Hub"), part of Washington's State Innovation Model (SIM) Round 2 Test Award. Its three key objectives are (1) stimulate and accelerate the uptake of integrated behavioral health and primary care, (2) support progress toward value-based payment systems (VBP), and (3) strengthen clinical-community linkages. We aimed to assess the status of primary care and behavioral health practices in these areas, describe the activities of Hub coaches, and identify barriers to implementing the Hub. Methods: This mixed methods program evaluation drew data from three sources: (1) the Washington Practice Transformation Assessment (WAPTA), a self administered 10-minute online survey; (2) a web based activity log used by Hub coaches; and (3) key informant interviews (KIIs) of Hub implementation stakeholders. We examined activity log data from 2017, and KII data from 2016 Q4 through 2017 Q3. Data was obtained from fifty-eight primary care and behavioral health practices, eight HUB coaches, and eighteen Hub stakeholders. Results: Of the three Hub objectives, practices reported being most developed in community linkages and least developed in VBP. Activity logs revealed that 29% of Hub coach activities in 2017 were focused on care integration, 19% were focused on VBP, and 11% on community-clinical linkages; the remainder were spread out among miscellaneous practice transformation topics. KIIs revealed several barriers to Hub implementation, including lack of perceived value in practice transformation, lack of clarity on the role of the Hub, and stakeholders feeling overwhelmed by competing priorities. Conclusions: Many Washington primary care and behavioral health practices report being less developed in care integration and VBP than in community clinical linkages. Key challenges to implementing Washington's Practice Transformation Support Hub include communicating the value of practice transformation, articulating the role of the Hub, and competing with other demands on practices' time.

CDC’s “6|18 Initiative: Accelerating Evidence into Action” aims to improve health and control costs by accelerating the adoption of evidence-based prevention strategies that address six high-burden, high-cost health conditions. Over the past two years, CDC, CHCS, ASTHO and other partners have provided targeted technical assistance to 17 teams of Medicaid and public health officials implementing 6|18 interventions, focused primarily at the state level. Participation in 6|18 has enabled states to reduce disparities in Medicaid enrollees’ access to disease prevention and control strategies, such as tobacco cessation treatments and long-acting reversible contraception. States articulated two types of successes stemming from 6|18 participation: (1) policy enhancements, including Medicaid payment changes and increased utilization of covered treatments; and (2) strengthened collaboration across Medicaid and public health to support population health goals. Examples of policy accomplishments include: State Plan Amendments to enhance Medicaid benefits; payment pilots; scope of practice regulations; and provider and member education to increase uptake of covered benefits. Strengthened collaboration across Medicaid and public health has led to: greater cross-agency accountability and resource-sharing; heightened leadership attention to prevention activities; and new partnerships on non-6|18 activities. Lessons from the 6|18 Initiative should be of interest to health care leaders and managers looking to adopt new prevention policies; foster a more collaborative working environment with diverse partners; and address the needs of-low income communities. Lessons include: (a) choose discrete, targeted interventions; (b) engage partners from multiple backgrounds to capitalize on unique skills and perspectives; and (c) define distinct yet complementary roles for partners.

Background: In order to address increasingly complex health challenges during a time of budget limitations, state government agencies must foster a culture of interdisciplinary thinking and cross-sectoral collaboration to increase efficiency, reduce health disparities, and improve health outcomes. In response to the national interest to embed health considerations into decision-making across all governmental sectors, or Health in All Polices, the Association of State and Territorial Health Officials (ASTHO) assessed the current level of state health leadership efforts toward cross-sector collaboration to improve population health. Methods: A mixed method assessment was conducted from 2017-2018 to describe the existing nature of cross-sectoral collaboration from the perspective of state health agency leadership. The assessment consisted of three distinct respondent groups that included: (1) key informant interviews with eight state health officials, (2) two focus group discussions with health officials’ senior deputies, and (3) an online survey of state health agency legislative liaisons. Quantitative and qualitative analyses were used to identify key trends in cross-sectoral collaboration on health priorities at the state-level. Results: Interview and focus group participants represented thirteen state health agencies from various regions, agency structures, budget climates, and state government political party alignments. Results present the cross-sectoral collaboration strategies state health agencies are currently implementing to improve population health. Additionally, the analysis identifies the formal and informal mechanisms that facilitate interdisciplinary population health problem-solving and the current priorities addressed through cross-sectoral collaboration. Conclusions: As state health leadership’s commitment to advance health equity through a health in all polices approach continues to grow, the findings of this assessment highlight opportunities to foster a culture of cross-sectoral collaboration and interdisciplinary thinking to address new and complex health challenges.

There is wide recognition that factors related to where we live, work, and play impact our health. As the health care system increasingly shifts away from fee-for-service payments and towards value-based payments, emphasizing quality of care and health outcomes, health care entities are incentivized to focus on the social determinants of health (SDOH) in the interest of improving health outcomes among patient populations. A first step is often to set up systems to screen patients for social needs. The Boston Area Hospitals Collaboration on the SDOH (the Collaboration) is a group of SDOH experts from the following health care institutions: Beth Israel Deaconess Medical Center, Boston Children’s Hospital, Boston Medical Center, C3, Cambridge Health Alliance, Partners Healthcare (including Massachusetts General Hospital, Brigham & Women’s Hospital, and Brigham & Women’s Faulkner Hospital), and Tufts Medical Center. The Collaboration was formed in Spring 2017 to facilitate joint planning for SDOH screening. As the health care institutions in the Collaboration began planning to participate in Medicaid Accountable Care Organizations and to screen their patients for social needs, there was recognition that coordination of SDOH screening across institutions could allow for the potential to pool data and collaborate on future joint projects. This collaboration is facilitated by Health Resources in Action, a public health institute. Presenters will share the process used to identify and prioritize common SDOH screening domains. Prioritized domains include: Housing, Food insecurity, Utilities, Transportation, Employment, Finances, Education, Caretaking, Experience of violence, and Health literacy. Alignment on these priority domains will allow institutions to pool data on their patients’ social needs, creating a powerful evidence base for understanding needs, advocating for additional resources, and tracking change over time. Presenters will also describe lessons learned for the role public health can play in building collaborations across health systems to address population health.