Funding from OneCare Vermont — the organization leading the state’s “all payer” experiment in health-care reform — is keeping an innovative and proven system of support for vulnerable Vermonters called SASH (Support and Services at Home) operating in all corners of Vermont.
Specifically, OneCare provides the funding for SASH care coordinators and wellness nurses, embedded in over 140 affordable-housing properties across the state, to serve low-income residents in subsidized housing as well as surrounding community members. In addition, OneCare is a strong collaborator with SASH in our work to coordinate with community medical providers and agency staff to help keep older Vermonters and those with disabilities living in their homes and communities.
Rigorous, independent evaluations of SASH over the past five years consistently show improved health outcomes along with slowed rates of health-care spending for some segments of SASH participants compared to a control group.
OneCare convenes regular meetings and trainings for cross-agency collaboration aimed at exploring innovative solutions to meet OneCare Vermont’s three primary goals: 1) to increase Vermonters’ access to primary care, 2) to reduce deaths due to suicide and drug overdose, and 3) to reduce prevalence and morbidity of chronic disease.
One example of an innovative solution funded in part by OneCare is a joint SASH-Howard Center mental health pilot program launched in late 2017. The program provides a Howard Center clinician who works at two SASH housing sites, providing flexible and same-day access to one-on-one therapy, informal emotional check-ins and a variety of group sessions on such topics as depression, anxiety and mindfulness. The pilot has shown impressive results, including an increase in access to mental health supports, reduced stigma for those seeking help, a lower risk of depression, and even preliminary trends of reduced emergency room utilization. This innovative and effective initiative would not have been possible without OneCare’s investment and ongoing support.
The all-payer model administered by OneCare Vermont allows for flexible, person-directed services and support. Support is provided at home, and the amount of time involved is dictated by the person being served instead of a fee-for-service billing increment. SASH staff might spend 15 minutes with a participant to finalize a referral or two hours to plan for a successful discharge home after a planned surgery.
With OneCare’s support, we are working on other initiatives to help prevent or better manage diabetes and hypertension among SASH participants. Our continued partnership with OneCare Vermont will strengthen our ability to measure the impact of these initiatives and provide the all-important flexibility needed so we can best serve participants in the manner, duration and setting they choose.
Molly Dugan is director of the statewide SASH (Support and Services at Home) program (sashvt.org), which operates in all 14 counties under the administration of Cathedral Square and in collaboration with a vast network of partner organizations.