Editor’s note: This commentary is by Molly Dugan, who is director of the statewide SASH (Support and Services at Home) program, under Cathedral Square, which is the statewide administrator for SASH.
Funding from OneCare Vermont is keeping an innovative and proven system of support for vulnerable Vermonters, 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 and surrounding community members to improve their health and remain in their homes and communities as long as they wish.
SASH has been evaluated by an independent third party for five years and has consistently shown lower rates of growth in health care spending for some segments of participants when compared to a control group.
Besides funding for these vital SASH program staff working where their participants live, we have found OneCare Vermont to be a strong collaborative partner in our efforts to coordinate with community provider organizations and medical providers involved in helping to keep older Vermonters and those with disabilities living in their homes and communities.
OneCare convenes regular meetings and training for cross-agency learning and collaboration and provides opportunities for these organizations to try out innovative solutions to meet OneCare Vermont’s three primary population health goals: 1. increase access to primary care, 2. reduce deaths due to suicide and drug overdose, and 3. reduce prevalence and morbidity of chronic disease.
An example of one innovative solution funded in part by OneCare is a mental health program we have operated with HowardCenter since late 2017. The mental health program provides a HowardCenter mental health clinician to work at two SASH housing sites, providing flexible and same day access to one-on-one therapy, informal emotional health check-ins and a variety of group sessions around such topics as depression, anxiety, and mindfulness. The pilot program has shown impressive results including an increase in access to mental health supports, reduced stigma to seeking help, reduced depression risk and even some preliminary trends of lower emergency room utilization. This innovative and effective initiative would not have been possible without OneCare Vermont’s investment and on-going support.
The value-based payment model available because of the all payer model agreement between the federal government and the State of Vermont and administered by OneCare Vermont allows for flexible and person directed services and support. SASH staff might spend 15 minutes with a participant to finalize a needed referral or two hours to plan for a successful discharge home after a planned surgery. Importantly, the support is provided at home and the amount of time is dictated by the person being served not a fee for service billing increment.
We are currently working with OneCare Vermont to partner around other initiatives to help prevent and/or better manage diabetes and hypertension among our participants. We believe our partnership will strengthen our ability to measure impact and allow for important flexibility to best serve our participants in the manner, duration and setting they choose.
