1. 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

2. 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

3. 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
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blueshieldcafoundation.org

4. 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

5. 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., Adapted from Figure 2.

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

7. behavioral health integration

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

9. California whole person care pilots
LA Housing for Health Program

10. 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

11. 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

12. 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

13. 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?
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blueshieldcafoundation.org

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