Disclaimer: Moving Health Care Upstream is a collaborative effort originally co-led by Nemours Children’s Health System (Nemours) and the Center for Healthier Children, Families & Communities at the University of California- Los Angeles (UCLA). The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of Nemours, UCLA or the Moving Health Care Upstream initiative.
Community Health Improvement Week 2020 (June 6-12) is a time to celebrate and honor those working in partnership to improve the health and well-being of individuals and communities. This year, as our nation moves further toward recovery and rebuilding after the COVID-19 pandemic, the American Hospital Association is highlighting three themes during Community Health Improvement Week:
- Reflect on health disparities illuminated by the pandemic and consider further actions needed to improve the health and well-being of all people.
- Renew commitment to community health improvement, including working with cross-sector partners to better serve our communities.
- Rise Together to strengthen our communities through collaborative and creative work and investment in our neighborhoods and one another.
In this blog post, Nemours Children’s Health System offers reflections from participants in the Nemours 2020 Integrator Learning Lab on the impact of the COVID-19 pandemic on the focus, functioning, and sustainability of their population health networks. We share these responses as an example of the Rise Together theme; interview responses illustrate the ability of strong population health networks to pivot in times of emergency to meet new demands. We believe many of the lessons learned from our partners are valuable to the field as we collectively try to understand the urgency of this moment; and the opportunity it creates to change the conversation on social determinants of health and cross-sector networks that are working to change systems and advance racial and health equity on an on-going basis.
Question 1: How has the pandemic impacted the focus and/or functioning of your population health network?
The pandemic led to a greater urgency to address pressing health equity concerns, including those related to racial and social justice issues. This urgency led to an uptick and re-focusing of network activity once teams addressed immediate needs. Learning Lab members reported increased support for the idea that networks could and should tackle multiple health-related social needs. As one Learning Lab member stated, “problem solving for one issue isn’t really limited to that one issue.” In some cases, this also led to groups outside of networks (external partners, funders, etc.) to increasingly recognize the importance of networks serving as population health integrators in the community.
The pandemic increased understanding of the connection between social determinants of health and social needs and contributed a broader view of data-sharing. The pandemic shined a spotlight on the inter-connection between social needs and their root causes- also known as the social determinants of health. It also shined a light on the need for networks to work on policy, systems, and environmental changes to address root causes as a way to stem the tide of social needs. Increased understanding of the connection between social needs and social determinants is leading to an increased sense of responsibility to use data to tell stories behind health disparities.
The pandemic contributed to public and private funding sources providing flexibility to fund work focused on health-related social needs- enhancing network sustainability. CARES Act dollars and local funds have been made available to teams to support innovations in contact tracing and housing. Network leaders reported that some foundations are more open to conversations about funding strategies that can move the needle on population-level measures of health and well-being, and less exclusively focused on outcomes for specific sub-populations in communities and/or health-specific outcomes.
Many networks found it easier to engage and sustain partners. The pandemic put an end to most in-person meetings and forced networks to meet virtually. This had the un-anticipated benefit of making it easier to engage with current and potential network partners by eliminating geographic distance as well as time spent traveling to and from meetings. Reducing the “cost” of participation in networks opened the door for more partners to participate in steering committees and other meetings. In addition, having formal relationships in place between cross-sector network partners at the start of the pandemic was an asset to leverage in a time of crisis. Existing relationships with partners from other sectors allowed networks to focus on the work of immediate community needs rather than spending time on building new partnerships during a crisis.
Question 2: To what extent do you anticipate that there will be shifts (good, bad, or neutral) in how your non-healthcare partners participate within the network; and how your health care partners participate within the network?
While budgets were impacted, most networks saw steady participation, if not an uptick in participation in their work. At least in the short-term, networks saw partners rededicate their energy to working collaboratively to meet needs. There is an ongoing question if this will last once organizations reassess their goals and bottom line.
The pandemic reinforced the need for working across sectors to address multiple, related social needs as well as the social determinants of health. Networks engaged with new and existing partners to collect and analyze data issues of interest to multiple sectors at the network table, such as adverse childhood experiences (ACES) or food insecurity and hunger.
Networks with established relationships and infrastructure were able to pivot and take advantage of new and/or expanded funding streams and partner opportunities. Experience working across sectors prepared networks for the coordinated responses necessary to get services to the most under-served residents quickly and efficiently. Formal relationships were protective, keeping partners at the table in the chaos triggered by the pandemic.
Negative pandemic-related impacts on participation and resources may be delayed. Networks worry that decreases in member participation and resources supporting the network strategies will become increasingly likely the longer the pandemic and associated economic downturn continue- since cities, states, etc. are likely to need to cut other programs/services to make up for COVID related spending and/or revenue decreases.
We invite you to learn more about our “Exploring the Roles & Functions of Health Systems within Population Health Integrator Networks” work, and to visit our collection of resources featuring videos, tools for action, and insights from the project.
Please contact us at [email protected] for more information.