June 14, 2019

Invitation Letter

Invitation to Participate in a Feasibility Study to Elicit Sustainable Local Investments in Upstream Social Determinants Healthy Opportunities

(aka Social Determinants of Health)

Convincing research evidence shows that investments in healthy opportunities (HO), more commonly known as social determinants of health, can improve health other dimensions of well-being for vulnerable populations while reducing health care utilization and a variety of health and social service costs. Nevertheless, adequate and sustainable financing of HO, such as quality housing, adequate nutrition, and targeted transportation, has eluded most if not all communities in the US.  In our view HO have properties like other public goods which benefit many stakeholders simultaneously and unavoidably.  These properties lead to “free-rider” problems and systemic underinvestment. 

Our recent Health Affairs article showed that a relatively obscure economic model – a Vickrey-Clarke-Groves auction – can help solve free-rider problems that arise in a HO context under certain conditions, namely, where a trusted information broker, relevant data, and reasonably collaborative stakeholders are available.  The beauty of the model is that it is powered by local stakeholder self-interest, and thus financing solutions do not depend on ever more government or philanthropic spending. This makes the model more likely to be sustainable than financing alternatives currently present.  Given local reactions to the ACA’s readmissions penalties and to the opioid crisis, as well as states’ increased reliance on Medicaid MCOs, the key pre-condition for this model to be applicable — local stakeholder coalitions searching for collaborative solutions to common SDOH problems — is spreading.  We infer this from the responses our paper has engendered from community stakeholder groups, individual members and local leaders from around the country.  We are gratified and energized by these responses. 

And now thanks to the generous support of the Commonwealth Fund, the Missouri Foundation for Health, the Episcopal Health Foundation, and X (maybe BSCF, KP, Scan, Hartford etc), we are thrilled to be able to offer a no-cost tutorial in how this model and its attendant processes might be applied in your community.  This invitation is open to any willing participant, whether they work for an existing coalition, health care provider or insurance organization, social service provider, local governmental unit such as a health or  social service agency, mayor’s office or county government, employer coalition, community advocacy organization, philanthropy, faith based organization, state government, or a consultancy that facilitates the work of any or all of the above, potential stakeholders all.

The tutorial we have in mind is partly didactic in that we and our collaborators at the Altarum Institute will teach the essential elements of the model as well as the attendant processes necessary to implement and evaluate it, including the mechanics of the economic model itself, coalition governance, data generation, data sharing, vendor contracting and rigorous project evaluation requirements.  But the feasibility study also entails a continuous process of mutual assessment, by us of local coalition and stakeholder capacities and commitment and by you of the model’s and processes’ potential applicability to HO in your community with your existing or potential collaborators.  This project is called a feasibility study literally because we and our funders will assess along with you the feasibility of implementing and testing the model in some of your communities in the coming months and years.    

The project will be guided throughout by a national advisory panel with deep experience implementing collaborative work in health and social service arenas.  It will kickoff with 4-5 webinars in June that will be archived for convenient asynchronous viewing and that will provide details of the model, governance considerations, lessons from the literature of prior HO interventions, data requirements, and demonstrations of the bidding, contract management, and data reconciliation processes necessary to sustain the model over time.  We will then assemble data on participants’ HO environments, from publicly available data bases and from local hospital CHNAs, as well as from local stakeholders yourselves.  In the last quarter of 2019 we will conduct site visits to the communities among you that seem most promising candidates for implementation and testing.  In early 2020 we will write a comprehensive report of lessons learned about which community characteristics are judged most conducive and most challenging to the model’s applicability and implementation.  Throughout the project but especially in the latter half of the 12-month feasibility project, we will help the willing among you to apply for funding to pay for the technical assistance to implement and evaluate your application of the model in your community.  We will then prepare implementation guides and tool kits for others to implement and evaluate the model over time as well. 

In order to sign up for the feasibility study, please register using the following link.  Dates and times of the live webinars as well as project contact information whereby questions may be answered will be provided to all registrants.

While the VCG model is likely not right for every locale or stakeholder group, we believe it has great promise for HO situations in a variety of communities.  Indeed, the range of communities, individuals and organizations that have already reached to us directly make the point.  We hope you can allow us to help you learn about this model and assess its applicability to the HO problems you and others like you face.  


Len M. Nichols and Lauren A. Taylor