Healthier Families, Adults, and Communities is one of four key outcomes APHSA seeks to impact through a transformed human service system. Through aligned and person-centered programs, flexible funding, meaningful accountability, and strategic partnerships, we can help control long term health care costs; facilitate a balanced continuum of care that begins with prevention; provide opportunities for essential health services; and link health and human services to support "no wrong door" access.
The necessary policy directions for healthier families, adults, and communities will require that we:
- use preventive approaches, leverage resources of the broader community, link and align programs to streamline administration and facilitate appropriate use of services, and take other steps that can improve long-term health outcomes and control their costs;
- link human service programs with health programs to reduce duplication, support single portal-of-entry access, and connect single adults, families, children, and seniors to essential health services;
- support a holistic spectrum of care opportunities including behavioral health, long-term care, and quality of life supports to vulnerable seniors; and
- provide opportunities for other basic supports that encourage health, such as the means to buy adequate food and medications, access to nutritious food choices, and access to affordable housing.
There is growing recognition that health can no longer be considered in isolation from either its broader family and community context or from the human service programs that often do—or could—support and strengthen health outcomes. The need for better, more sustainable, and more cost-effective health outcomes must rest on a network of strong families, supportive communities, integrated public-sector programs, and other foundations that will support sustainable independence and personal success. Achieving these priorities can be helped through such means as an appropriate continuum of care; community-based care options; strengthened attention to populations such as those with behavioral health needs and people with disabilities; and modern, integrated information systems that allow the free flow of essential health information and reflect today's consumer-oriented marketplace.
The health of families, adults, and communities rests on access to essential health services and to appropriate care across the health care continuum. This continuum begins with prevention and includes such critical components as primary and secondary (or specialty) health care, mental health, substance use services, and supports for people with disabilities. It ends with long-term care and other services for seniors, both institutional and home- or community-based. The coordination and integration of this entire continuum improves the overall health of children, individuals, and families and decreases the economic and societal costs that would otherwise occur when conditions are left untreated—or handled in a siloed manner, as often occurs now since many components are housed in separate systems. Those needing specialized (secondary) care have limited options under Medicare or Medicaid, making access to specialty care providers difficult for those needing more than primary care practitioners can offer.
This integrated continuum of care also depends on the scope and structure of community-based care and on coordination among elements of the service delivery network. A strong public health and health care delivery system helps assure sustainable outcomes for all populations; community health and individual health are interdependent.
Coordination and integration of mental health and substance use disorders (behavioral health) are also critical for achieving healthy outcomes since many persons have both disorders—the so-called co-occurring or dual-diagnosis individuals. Recent federal initiatives have begun to offer funding to states for this type of care, and other initiatives have focused on the coordination of behavioral and physical health care. This need is also pressing for "dual eligibles," or those who participate in both Medicare and Medicaid. Misalignment across these programs has a substantial impact on these high-cost populations.
For people with disabilities and older adults, holistic health also depends on quality of life measures such as engagement in community life or employment. The increasing number of those over 65—many of whom have chronic, complex health conditions—has significant implications for the affordability and sustainability of the health and human service system. Health coverage provided to people with pre-existing conditions; mental health and substance use parity; initiatives to coordinate care and reduce costs for the dual population; and opportunities for community- and home-based care are all essential to a successful and cost-effective approach to these health challenges.
Nutrition, employment supports, supportive housing, and other supportive social services are other key elements that are typically separate in structure and administration, yet also play direct and vital roles in health and disease management. Access to food-related programs and opportunities for healthy food choices can be essential to the health of individuals and families. Greater integration of federal nutrition assistance programs into the larger framework of health and human service programs is critical for important health outcomes.
A growing concern—requiring person-centric, culturally relevant service initiatives—is the health disparity among populations defined by race/ethnicity, socio-economic status, geography, gender, age, disability status, and other at-risk factors. These populations require such approaches as utilizing the community, the public, and the private sector; engaging foundations and other local stakeholders; increasing the usage of Federally Qualified Health Centers (FQHCs) and person-centered medical homes; and providing bi-lingual screening and services. For this outcome, APHSA proposes the following major policy priorities. See additional APHSA policy publications in the Pathways series for detailed discussions of these and related policy issues.
Public Policy Should:
- Support program development, program alignment, and integrated and flexible financing to help control costs and facilitate integration of health and human service programs, with human services as a full partner in the development and infrastructure of health systems.
- Support holistic and client-centered services, the interoperability and integration of programs, "no wrong door" access to coverage options, and adequate agency and workforce capacity, all of which are critical to better health and functioning.
- Support alignment and care coordination models, which are essential for promoting comprehensive health and human service delivery and ensuring access, quality, and lower cost. New financing models and flexibility for states to test financing and payment reforms could advance care coordination between primary and secondary health care, and bring to scale evidence-based and preventive practices for the bi-directional integration of behavioral health and with primary care.
- Encourage investments for prevention and early intervention that avoid future dysfunction and costs; address the social determinants of health across the lifespan; and support "rebalancing" efforts that transition long-term support and service systems from institutions to home- and community-based settings.
- Support access to food assistance programs, supportive and affordable housing programs, homelessness services, and community-based efforts that can facilitate improved health outcomes.