Healthy Sonoma Stephan Betz, Ph.D.

Projects Nightingale: Continuum of Care and Whole Person Care Sustainable Financing Portfolio

Nightingale: Continuum of Care and Whole Person Care

Medi-Cal 2020: Improve health care quality and outcomes Strengthen primary care delivery and access Build a foundation for an integrated health care delivery system that incentivizes quality and efficiency Address social determinants of health and improve health care equity Use CA’s sophisticated Medicaid Program as an incubator to test innovative approaches to whole-person care

Goals To achieve the 2020 Vision for Sonoma County, Health Action drew upon existing research to identify the following 10 goals that would significantly contribute to a healthier community:

1.Youth graduate from high school on time. 2.Families have the economic resources to make ends meet. 3.Residents are connected to their communities and participate in community life. 4.Residents eat healthy food. 5.Residents are physically active. 6.Residents do not abuse alcohol or prescription drugs and do not use tobacco or illicit drugs. 7.Residents enjoy good mental health. 8.Residents take steps to prevent injury. 9.Residents have health care coverage. 10.Residents are connected with a trusted source of prevention-focused primary care that coordinates patient care across the continuum of health care and community-based services.

1.Youth graduate from high school on time. 2.Families have the economic resources to make ends meet. 3.Residents are connected to their communities and participate in community life. 4.Residents eat healthy food. 5.Residents are physically active. 6.Residents do not abuse alcohol or prescription drugs and do not use tobacco or illicit drugs. 7.Residents enjoy good mental health. 8.Residents take steps to prevent injury. 9.Residents have health care coverage. 10.Residents are connected with a trusted source of prevention-focused primary care that coordinates patient care across the continuum of health care and community-based services.

CENTERS FOR MEDICARE & MEDICAID SERVICES EXPENDITURE AUTHORITY NUMBER: 11-W-00193/9 TITLE: California Medi-Cal 2020 Demonstration AWARDEE: California Health and Human Services Agency CENTERS FOR MEDICARE & MEDICAID SERVICES EXPENDITURE AUTHORITY NUMBER: 11-W-00193/9 TITLE: California Medi-Cal 2020 Demonstration AWARDEE: California Health and Human Services Agency Delivery System Transformation and Alignment Payments

Whole Person Care (WPC) Pilots. Such expenditures may include payments for -services, -supports, -infrastructure and -interventions, which may not be recognized as medical assistance under Section 1905(a) or may not otherwise be reimbursable under Section 1903, to the extent such services, supports, infrastructure and interventions are authorized as part of an approved WPC pilot program. CENTERS FOR MEDICARE & MEDICAID SERVICES EXPENDITURE AUTHORITY NUMBER: 11-W-00193/9 TITLE: California Medi-Cal 2020 Demonstration AWARDEE: California Health and Human Services Agency CENTERS FOR MEDICARE & MEDICAID SERVICES EXPENDITURE AUTHORITY NUMBER: 11-W-00193/9 TITLE: California Medi-Cal 2020 Demonstration AWARDEE: California Health and Human Services Agency Delivery System Transformation and Alignment Payments

Whole Person Care (WPC) Pilots. Such expenditures may include payments for -services, -supports, -infrastructure and -interventions, which may not be recognized as medical assistance under Section 1905(a) or may not otherwise be reimbursable under Section 1903, to the extent such services, supports, infrastructure and interventions are authorized as part of an approved WPC pilot program. WPC

The Sonoma County Nightingale Project: A step down from high acuity to community based living for high need clients WPC

Sustainable Financing Portfolio

Medi-Cal 2020: Improve health care quality and outcomes Strengthen primary care delivery and access Build a foundation for an integrated health care delivery system that incentivizes quality and efficiency Address social determinants of health and improve health care equity Use CA’s sophisticated Medicaid Program as an incubator to test innovative approaches to whole-person care

Sustainable Financing Portfolio

SOUND STRATEGY ACTIVE STEWARDSHIP SUSTAINABLE FINANCING ReThink Health National Dialogue: Bridging Health and Health Care So Communities Can Thrive

Strategic Planning Update

COUNCIL PLACE-BASED STRATEGY: Health Action Chapters LOCAL POLICY: City Council Liaisons Committee for Healthcare Improvement Cradle to Career Economic Wellness

SOUND STRATEGY ACTIVE STEWARDSHIP SUSTAINABLE FINANCING ● Data-sharing ● Shared outcomes ● Agency and leader stewardship ● Strategy for policy advocacy ● Communication ● Sustainable financing and funding ● Backbone staffing

Sonoma County Health Action Catalyst Team Catalyst Team SUSTAINABLE FINANCING Diverse Team Investigate the State of the Field Determine Local Approach Recommend Next Steps

Goal: Develop a system of sustainable financing that can be applied to a range of investments to best address Sonoma County’s health priorities. Catalyst Team SUSTAINABLE FINANCING

What does sustainable mean to us? Diverse and reliable funding sources Sufficient funds for desired outcomes Investment shows demonstrable monetary and societal returns Catalyst Team SUSTAINABLE FINANCING

How is this different from “business as usual?”  Invests in prevention strategies & system change approaches for specific Health Action desired outcomes  Prioritizes investments that demonstrate value  Favors non-traditional models to attract external and new funds Catalyst Team SUSTAINABLE FINANCING

Pool Funds/ Initial Investment Determine Savings & Value Improved Health Outcomes Evidence- Informed Service Delivery Pay for Success Accountable Communities for Health Prevention & Wellness Innovation Fund

Backbone Funding Pooled Funding Innovative Loan Funding Based on HA priorities – funds directed by Health Action Council Public Funds Membership Fees Fundraising Other Facilitation & strategy development Data sharing systems & evaluation Communications & community engagement Advocacy & Policy Development Based on HA priorities – funds directed by investment group through local foundation Local Funders Traditional Funding Sources (Grants, Community Benefit) External investors looking for proof of concept Health Action Outcomes Capacity-building Pilot testing non- traditional funding methods Proof of Concept work Based on HA priorities – funds directed by a loan intermediary (i.e., CDFI) External/Large investors Health District Health Action Outcomes Scaled up programs Receive & give loans Large & long-term investments Capture and reinvest Structure

Catalyst Team SUSTAINABLE FINANCING Accountability & decision-making structure? How can projects be prioritized? How could funds or projects that don’t coincide with Health Action priorities be managed? Where could it be housed? Fund Analysis Where could funds come from?

SOUND STRATEGY ACTIVE STEWARDSHIP SUSTAINABLE FINANCING Foster the role of Health Action members as contributors, investors and stewards of the Fund Launch a pooled fund and test innovative approaches Develop Health Action Business Plan Next Steps