HSTRC Conceptual Framework
Goal: Promoting Health Equity for Medicaid-Eligible Populations
Literature Search Key Takeaways
Between July and December 2019, Avalere conducted a targeted white and grey literature search using a variety of sources to assess the current state of how health systems address the interrelated goals and needs of Medicaid-eligible individuals. Findings and key takeaways from the literature search comprise this research directory that houses synthesized learnings from the environmental scan as well as emerging evidence.
Though the research directory features key takeaways for each source, several findings emerged as promising characteristics of models that address the interrelated goals and needs of Medicaid-eligible individuals, including:
Multidisciplinary care approach
Successful models include a wide range of providers, including primary care, behavioral health, and community providers in interventions. These approaches may feature community-based providers, interdisciplinary care teams, or referrals to community-based organizations.
Screening for social needs
Assessment forms or other screening tools can be used to identify social needs among potential model/program participants
Use of technology
Successful models adeptly leverage technology (e.g., electronic health records (EHRs), electronic screening tools) to identify and track patients at social risk and patients’ unmet social needs, exchange data with community providers (to the extent possible), and deliver care (e.g., through telemedicine), when appropriate
Establishing and tracking metrics
The strongest models identified metrics early in model implementation and tracked patient-centered outcomes internally as well as for evaluation purposes
Further research is needed to understand how to scale successful models, identify a more robust set of metrics that assess both clinical and social outcomes, and ensure robust and longitudinal evaluations. Research from the HSTRC grantees will help close gaps in knowledge and answer outstanding questions about scale and spread.
Progress To Date
Since HSTRC’s launch, we have completed several project milestones:
Launched the Research Collaborative
We launched the Research Collaborative, which is intended to be a neutral, centralized management entity to coordinate funders, health systems leaders, and researchers to discuss how research can be used to transform health systems and advance health equity for Medicaid-eligible populations. The Research Collaborative’s goals and objectives are guided by a 12-member Advisory Board.
Published a Research Agenda
Published a Research Agenda to strengthen the evidence around care models that address the interrelated goals and needs of Medicaid-eligible populations. The Research Agenda outlines: 1) priority components for health systems models of care addressing the needs and goals of Medicaid-eligible individuals, 2) HSTRC activities to support the implementation of the Research Agenda, and 3) Potential priority focus areas for grantmaking related to comprehensive system models of care and, as well as the resources and mechanisms that could facilitate long-term sustainability.
Distributed $2.7M in Funding
Leveraging the Research Agenda, the HSTRC team distributed $2.7M in funding to 9 grantees that are conducting promising research that addresses evidence-based activities that could potentially be leveraged by external stakeholders. Grantee research is intended to evaluate the extent to which integrated health systems models of care are advancing health equity for the Medicaid-eligible populations they serve.
Developed a Communications Plan of Action
Developed a Communications Plan of Action which outlines overarching goals, objectives, and specific tactics for disseminating learnings and key findings from HSTRC grantees to target stakeholder audiences.
Initiated the Development of a Sustainability Plan
Initiated the development of a Sustainability Plan which outlines milestones, potential funding and research partners, and reporting metrics to ensure that HSTRC work is sustained beyond 2022
Upcoming Activities in 2022
As HSTRC looks ahead to upcoming activities in 2022, our vision is to continue accelerating the spread of care delivery models that advance health equity for Medicaid-eligible populations. HSTRC will translate the work of grantees into actionable resources to spread their learnings to interested stakeholders who may be interested in leveraging these resources. This website will continually be updated on an ad-hoc basis as a central repository of relevant resources, compiling emerging evidence and grantee research progress. To sustain evidence generation beyond 2022, we intend to recruit additional funders to help sustain and spread the work that our HSTRC grantees are doing.