Key Linkages: A Foundation Works Across Sectors to Help Vulnerable Populations

Massachusetts and the Blue Cross Blue Shield of Massachusetts Foundation have long played a central role in the conflicted evolution of state and national healthcare. Notably, BCBSMAF was a catalyst and champion for Massachusetts’ landmark health reform law in 2006, itself widely recognized as a precursor and model for the Affordable Care Act, aka Obamacare.

BCBSMAF currently focuses its grantmaking in the fields of social equity and health, behavioral health, and coverage and care, specifically for low-income and vulnerable people in the Bay State. This is terrain with complicated problems, where solutions must involve multiple stakeholders. So it’s not surprising that BCBSMAF is keenly interested in cross-sector strategies—approaches that have been increasingly deployed by funders seeking gains in public health and well-being, particularly of vulnerable communities.

“While there is a comprehensive array of programs that support low-income and vulnerable people in Massachusetts, navigating a complex world of healthcare and human services remains a problem for many,” Celeste Lee, BCBSMAF’s senior director of grantmaking, told Inside Philanthropy.

A Lack of Cooperation

Like so many health funders these days, BCBSMAF is supporting an upstream approach to health that includes social determinants. But it also sees a lack of cooperation between Massachusetts service providers that has blocked change.

“Social determinants, which greatly affect the health and well-being of individuals, are often identified and delivered in a siloed and uncoordinated fashion,” said Lee. “The systems responsible for providing services, including healthcare, housing, food access, and workforce development, among others, usually operate separately and lack the ability to share resources.”

Within the current social equity and health focus, BCBSMAF is particularly interested in helping providers across various health and human services industries collaborate. As Inside Philanthropy has reported, this approach has been gaining momentum:

Cross-sector collaboration has gained a lot of traction in the public health field, where such top funders as the Robert Wood Johnson and the Kresge foundations are backing similar initiatives, most notably the BUILD Health Challenge, which seeks to improve wellness by bringing together community-based organizations with local hospitals and public health departments… The idea behind all these efforts is that solutions to complicated problems touch on many areas, and require coordination from multiple stakeholders and systems.

A Team Approach

To build better coordination between these separate organizational silos, BCBSMAF is funding a new program called “Going Beyond Health Care: Addressing Social Determinants through a Cross-Sector Approach.” Within this project, a planning year and two-year grant program will aim to build “the capacity and infrastructure for interdisciplinary teams to coordinate in addressing clinical and nonclinical needs for low-income and vulnerable populations across the age spectrum.”

The plan is for each team to be led by a social service organization and to include healthcare and human service organizations that will work together to assist individuals and families. Lee says the planning and implementation of cross-sector strategies during the three years of the program can potentially serve as models for the rest of the Commonwealth.

Another example of BCBSMAF's support for upstream and team-based change-making in the past few years is its co-funding of Health Starts At Home, an initiative hosted by The Boston Foundation that backs teams of health and housing groups.

Lee also shared BCBSMAF’s current outlook on behavioral health, and coverage and care. Regarding behavioral health, she said the organization intends to address key challenges including the insufficient behavioral health workforce and treatment capacity across the state, and the rising costs of related treatments.

In this field, the foundation is launching a new grant program called “Expanding Access to Behavioral Health Urgent Care.” Lee said her organization's goal in this realm is to support established collaborations consisting of emergency services programs and other community-based affiliated providers.

Again, we see this funder backing cooperation. Through the program, BCBSMAF intends to “develop a shared vision of a model for the delivery of [behavioral health urgent care] in Massachusetts,” Lee says.

In relation to its coverage and care priority, Lee told us that while Massachusetts has an unusually high 97.2 percent of its population insured, some longtime problems persist for underserved communities. These include a complicated paperwork system that can be a barrier to consistent and appropriate coverage, “significant threats to the Affordable Care Act,” and numerous questions about the future stability of Medicaid and coverage subsidies. Coverage distribution is also a concern—Lee noted that “there are geographic and subgroup variations to the insurance rate, whereby certain regions or demographic groups are more likely to remain uninsured.”

According to Lee, as BCBSMAF works to improve healthcare access for low-income and vulnerable people, it targets three types of groups with its grantmaking: providers who serve and seek to improve care for these populations, advocacy organizations that try to preserve access to coverage and care, and that promote “consumer education and engagement,” and policymakers who rely on this funder’s research and grantmaking data to support policies that transform and protect health care.

BCBSMAF will review proposals for both the social determinant cross-sector approach and urgent behavioral care programs described above through the fall, and grant awards will be announced in December.

Massachusetts is a diverse state and should prove an effective laboratory for cross-sector programs. IP will continue to follow BCBSMAF’s cross-sector initiatives to see how this latest experiment develops.