Integrating Health and Human Services

Official Statement of Philanthropy New York on:

Integrating Health and Human Services

“Health & Human Services” have long been paired in nonprofit vernacular, but the reality is that the health sector and the human services sector operate in almost entirely separate systems.  This lack of integration remains, despite the growing recognition of the social determinants of health and the two sectors’ common reliance on government contracts as the primary source of operating revenue. 

New York is among a small group of states leading the way to health and human services system integration with an initiative aimed at overcoming the many serious barriers. Compelled by the growing body of research on the impact of social factors on health – and with strong incentives from federal mandates to tie health payments to overall population health outcomes – New York State is working toward a value-based payment (VBP) structure for health services. According to the Human Service Council report “Integrating Health and Human Services: A Blueprint for Partnership and Action,” the aim is to create a new structure that “will reward positive outcomes, or value, rather than volume of services provided. A critical element of this transition is the integration of health and human services.”

The report is the product of HSC’s Commission on Value-Based Care (Philanthropy New York was a part of that commission), which found that “the paradigm shift from volume-driven to value-driven care presents both great opportunity and great challenges for human services CBOs, and that government, as the principal buyer of their services until now, must take decisive action to strengthen these organizations, modernize the regulatory framework within which they operate, and foster cross-sector partnerships that truly incentivize positive outcomes.” In short, New York State must take deliberate steps to foster the transition. If done well, integration of these systems can lead to better population health and a more sustainable human services nonprofit sector with more diversified funding streams.

The blueprint suggests that New York State should act to:

  1. Bridge the technology divide between health systems and CBOs
  2. Undertake a comprehensive review and overhaul of regulatory requirements
  3. Make investments and build systems that support stronger and more informed relationships between the healthcare system and human services CBOs
  4. Provide greater and more targeted support for establishing provider networks
  5. Address contractual barriers to VBP participation
  6. Ensure that measures of social determinants of health interventions make sense and are relevant to population health goals
  7. Shift risk incrementally and commensurate with service level

As the Commission’s report notes, New York State’s Delivery System Reform Incentive Payment Program (DSRIP) set us on a path toward a more cost-effective and sustainable system that delivers better care, better health and lower cost for all New Yorkers, but additional collaboration, strategic investment, targeted assistance and regulatory reform is necessary. New York State should take a proactive role, as the primary payer, to advance system integration.

For these reasons, Philanthropy New York has adopted the following position statement:

Philanthropy New York endorses the recommendations of the HSC Commission on Value-Based Care and its conclusion that New York State government should exert leadership in implementing those recommendations.

Date of recommendation by the Public Policy Committee: September 27, 2018
Timeframe of open member commentary period: October 15, 2018-October 26, 2018
Date of official approval by Board of Directors: October 30, 2018