With recent disruptions to federal funding of social care programs, many communities are finding workarounds, alternative funding sources, and streamlining their program management and service delivery. How can your community maintain resilience in its social care networks? David Lewis, our VP of Strategy and VP of the Board for the National Human Services Data Consortium (NHSDC), gives his perspective on that question.
During my career, I’ve worked as an HMIS administrator, as a policy consultant to community-based organizations (CBOs) and healthcare organizations, and now as a partner to social care organizations across the country. In these roles, I’ve witnessed the critical importance of establishing safety net resilience by carefully blending technology and policy, which enables communities to fully leverage their capacity and capabilities.
Achieving resilience as a social care network often feels out of reach, especially when navigating policy challenges, privacy laws, funder compliance requirements, and the competing interests of participating CBOs. Despite these challenges, resolving the issues that limit care system resilience is essential for communities to achieve and sustain stability.
New political administrations frequently disrupt human services priorities and funding. Within mission-driven organizations that provide social services and healthcare using public funds, these disruptions understandably make clients and providers anxious about the future.
Times of policy or economic uncertainty reinforce the importance of social care networks and the cross-sector collaboration that defines them. When resources are most constrained, the technology that supports these networks becomes even more crucial, acting as a force multiplier. It enables overtaxed caseworkers and communities to engage more effectively in strategic planning and resource allocation, humanize case management, and empower vulnerable populations to participate actively in their care.
Basically, technology that aligns with the needs of social care networks is the foundation for resiliency. So, how can you make your community’s social care network more resilient?
Constraints Spark Creativity: Adapting to Social Funding Cuts
Marcus Aurelius famously observed, “The impediment to action advances action. What stands in the way becomes the way.” This insight applies to many situations—especially ones with high stakes—where new obstacles debilitate our efforts.
Said another way, “What stands in the way points out our new direction.” And sometimes, that new direction is an opportunity, even (maybe especially) during difficult circumstances.
As the HMIS administrator for the City of Spokane, Washington, I experienced firsthand the challenges associated with operating in a resource-constrained environment. In the world of social-services case management, it’s generally safe to say that the needs of vulnerable populations consistently exceed the capacity of the resources available. This sad reality is the one that anyone who has worked within the health and human services industry must face, and it makes collaboration all the more necessary.
There’s a parallel to natural disasters. Consider the Los Angeles wildfires earlier this year, or Hurricane Helene last year: communities pulling together in the recovery effort have a unique opportunity to strengthen their infrastructure, climate and environmental management, zoning laws, disaster response, emergency services, and so on.
Similarly, people came together in the wake of the Covid-19 pandemic, which brought to the forefront of public attention:
- healthcare inaccessibility,
- distrust in public health institutions,
- fragile supply chains, and
- environmental inequities.
Today, communities are grappling with substantial cuts in federal funding and technical assistance, coupled with a growing number of vulnerable citizens in need of services. To navigate these challenges, they need to embrace strategic and purposeful collaboration, just as they have during tough times in the past. And similarly, information technology will be essential to supporting and channeling collaborative efforts.
Federal Entitlement Spending: HUD, HHS, and More
When it comes to policy changes during the current administration, many of those funding decisions are being litigated: some Trump administration cuts have been ruled against, paused by their department heads, or canceled entirely. Others have been enacted or are on their way to being enacted.
HUD, Victim Services, and Work Requirements
The Department of Housing and Urban Development (HUD) has a few things going on right now. Secretary Scott Turner has stated that the Continuum of Care (CoC) program will resemble more of a block grant funding process, but that hasn’t yet been enacted. Our ClientTrack compliance experts here at Eccovia anticipate that gender data fields will not be required by HUD and that sex data fields will be required.
Earlier this month, HUD froze $60 million in affordable housing projects development earmarked by Congress.
In early February, the US Interagency Council on Homelessness (USICH) announced a CoC funding increase of $3.16 billion, but the linked HUD announcement does not appear, which also implies the still-ambiguous nature of funding right now.
Work requirements for SNAP are not new, but there’s been recent advocacy from some lawmakers for Medicaid work requirements. Until recently, Georgia was the only state with Medicaid work requirements. Earlier this month, Idaho lawmakers passed work requirements as a part of Medicaid expansion. Ohio, Kentucky, and Arkansas are among other states proposing it this year.
Victims of Crime Act (VOCA) funding has seen some decreases in Wisconsin and Washington, while funding opportunities from the Office on Violence Against Women (OVW) have been removed.
HHS Policy and Funding
The Department of Health and Human Services (HHS) is the largest grant-making agency in the federal government, and some of these programs affect care coordination efforts:
- Medicare reimbursement to physicians was approved by Congress to decrease by 2.8%.
- The Kaiser Family Foundation started tracking each state’s funding of Section 1115 Waiver Programs, which governs reimbursement for nontraditional Medicaid/Medicare funds targeting SDoH. Many states’ qualifications for Section 1115 are being adjusted but the funding availability doesn’t seem to have changed drastically.
- In February, CMS (Centers for Medicare and Medicaid Services) defunded the Affordable Care Act (ACA) navigator program by 90%.
Some of these above-mentioned changes might, well, change again. I always encourage communities to plan for possible scenarios while speculating as little as possible. Overthinking future scenarios can be a distraction.
What Happens When Social Care Is Fragmented?
Let’s suppose an unsheltered, homeless individual visits the emergency room because of a respiratory illness. They’re having difficulty breathing, have no insurance, and need an ambulance. Maybe they have a substance use disorder and psychiatric illness, both of which make it difficult for them to navigate structured environments and get care, housing, income, and so on.
What happens then? While many hospital systems, emergency shelters, street outreach teams, and criminal justice workers do referrals for social services, how do they ensure the patient is receiving help, especially when they are experiencing many comorbidities? Who’s supposed to follow up?
When this client is released from the ER with an inhaler, what happens when the medicine runs out and they have another asthma attack? It’s likely they’ll return to the ER, require first responders, or worse.
This all-too-common phenomenon is clinically known as a super-utilizer: a client whose chronic, unaddressed conditions lead them to frequently seek high-cost treatment for acute conditions in the short term. Predictably, those unaddressed conditions often lead to repeated interventions and encounters.
Super-utilization is a persistent challenge for communities across the country. Identifying and addressing the needs of these individuals is a priority, but all too frequently, software and related tools lack the features needed for achieving effective and long-term solutions, not to mention the siloes that many service providers and agencies experience.
Coordinated Access/Entry for Homelessness Services
Fragmented social care not only correlates to high costs—individual and public—but also to lower public health and safety. That’s one reason there’s a renewed push for permanent supportive housing (PSH) and other housing services, which are found to have benefits for lessening ER visits and hospitalization.
Many communities, as a result, are seeking improvements to the HUD-mandated coordinated entry requirement, a process where homeless individuals can receive intake, assessment, navigation, and referral for housing, shelter, or other SDoH services via multiple points of entry.
(By the way, I’d be remiss if I didn’t plug our webinar series on the subject, where we talk with three communities whose improvements to their coordinated entry systems led to better community outcomes. Sign up here to check it out!)
Downstream Consequences of Siloed Social Systems
When healthcare, behavioral health, HMIS, law enforcement, emergency services, and domestic violence services (in any combination) don’t coordinate, many issues occur:
- duplicate client records and services
- conflicting assessments
- worse client outcomes
- poor data quality
- long referral “loops”
- greater client distrust in agencies and providers
- lower public safety or repeated police encounters
- strained resources, higher community costs
While coordinated entry is one of the huge steps for care coordination to take place, it’s not the end-all and be-all. Rather, it points the way to further collaboration.
Care Coordination: Frameworks and Considerations
Super-utilization usually comes from different factors compounding together, like chronic disease, and SDoH factors like unemployment, behavioral and mental health issues, domestic violence, and homelessness. What’s more, these factors aggravate one another: someone without a job will have a hard time escaping the cycle of homelessness; homelessness often aggravates behavioral health and substance abuse issues; and behavioral health and substance abuse issues obstruct opportunities for employment. It becomes a mutually-reinforcing problem.
However, the framework many communities are now implementing to break that cycle is known as community care coordination.
There are many approaches to care coordination beyond coordinated entry (also called coordinated access) for homelessness services. Partnerships between healthcare, housing services, behavioral health, and beyond can create adaptive networks that care for the whole person and address their underlying challenges.
That’s why I like to talk about “cross-sector” collaboration: healthcare organizations can serve as points of entry for housing services, while jail diversion or harm reduction facilities can be linked to food-and-nutrition or substance abuse services, and so on.
Here are some concrete examples of what I mean.
Sharing Resources and Technology
When communities run into obstacles to their funding, it’s time to consider new strategies. That’s one reason some metropolitan areas merge their administrative services, sharing the cost burden and freeing up administrative overhead so they can focus on their core mission.
One example is the Metropolitan Alliance of Connected Communities (MACC), which supports service providers in the Twin Cities, Minnesota, area through a shared administrative services model, including sharing HR, IT, consulting, advocacy, finance and accounting, data services, and executive directorship.
By leveraging ClientTrack, our data-management platform, MACC organizations were able to:
- save significant costs by sharing one data platform, with separate workgroups for security;
- streamline program management and eliminate the need for spreadsheets;
- automate data workflows and client intakes;
- drastically increase data quality over time;
- improve data collection practices for clients’ data justice needs; and
- coordinate care between service providers and agencies.
Moving forward, I strongly encourage communities to find other ways to care for the whole person by establishing mission-centric partnerships. Often, our organization partnerships and affiliations within healthcare and social services begin with interpersonal relationships, but we need to plan for their enduring after founding partners leave.
Sharing Processes and Frameworks
Speaking of partnerships, cross-sector collaboration works best when SDoH outcomes are accounted for between complementary organizations. Large faith-based charities, for example, carry unique positions of trust among members of their faith community and among vulnerable migrants. Nonprofit medical or behavioral health networks, too, are in a singular position to refer patients to SDoH services that would help mitigate further acute complications. So when multiple organizations work together, they can expand their reach to more subpopulations who might not have sought their services before.
To the former example, see the work being done by Catholic Charities of Palm Beach (CCPB). This big-tent charity contributes to many programs that are all regulated in different ways, like transitional housing programs, anti-human-trafficking initiatives, and pre-natal care.
By getting case managers and workers across its network on the same framework and client management processes, CCPB saw:
- seamless screening for housing, Medicaid, SNAP, and other benefit enrollments;
- personalized care plans for elder care services and other vulnerable clients; and
- improved service management across the entire portfolio.
Check out our case study about their work!
And then there’s Houston, where the Greater Houston Community Coordination of Care (C3) pilot program saw an opportunity to integrate networks of behavioral health providers with other social programs. This network shared care coordinators from local community health centers to help vulnerable behavioral health clients navigate the social care programs they would qualify for.
Admittedly, enrollments dropped in the second year of the program because of the Covid-19 pandemic, but the proof of concept was there. Enrolled clients reported:
- resolved barriers to achieving better health;
- improved Daily Living Activity 20 (DLA-20) assessments;
- increased confidence in navigating community resources on their own; and
- fewer ER visits or fewer days of hospitalization.
Similarly, Physicians CareConnection (PCC), a charitable healthcare network of volunteer providers, needed a way to upgrade from electronic medical records to account for SDoH so they could care for the whole person.
Upon establishing a comparable database and tracking SDoH within ClientTrack, PCC was able to:
- prove its improvement of infant mortality rates, as requested by a unique grant;
- coordinate care within its network for nonmedical services; and
- look beyond clinical data to account for clients’ lived experience.
(We also have a case study about them!)
Final Thoughts on Funding
There will never be enough funding in the world to meet every individual client’s complete set of needs or pay for every program needed. So even at the best of times, we need to innovate, to find new ways to share resources.
At times, we’re forced to make tough budget trade-offs between quality-of-life care and life-saving care. (And of course, if it comes down to it, essential life-saving care should win out.)
So if you’re looking for advice on what to prioritize, here’s what I’d do:
- Maintain essential services that can save lives. (I know, it really is all essential, and it feels harshly “utilitarian” to think in those terms.)
- Implement data-sharing agreements within your community so intake, coordinated entry/access, or referrals are uniform.
- Leverage community partnerships to support whole person care, so SDoH clients aren’t repeatedly experiencing acute conditions.
- Advocate for local/state government agency support for integrated care. Frame it in terms of client outcomes and lower spending on emergency services.
Soon, I’ll write about various funding models and hope to help your community think outside the box of what it usually does for funding sources.
Take it from me: I’ve seen many communities make do with what they had, and while there will always be trade-offs we have to make, sharing resources when we have a shared mission is the most important thing. Social care networks are resilient when they adapt, innovate, and prioritize.
David is an accomplished human services professional with many years’ experience in HMIS administration, data management, and social services partnerships. As VP of Strategy at Eccovia, David leads the effort to expand our products’ and services’ potential to improve human lives, through educating ClientTrack organizations and bringing together new partnerships in service of care coordination across the United States. He also serves as VP of the Board for the National Human Services Data Consortium (NHSDC), which provides information, assistance, peer-to-peer education and lifelong learning to human service organizations via in-person and virtual events, as well as self-learning resources.
