@article{e7a22b9dba3a44f4b7f8664504ea5891,
title = "Medical-Financial Partnerships: Cross-Sector Collaborations Between Medical and Financial Services to Improve Health",
abstract = "Financial stress is the root cause of many adverse health outcomes among poor and low-income children and their families, yet few clinical interventions have been developed to improve health by directly addressing patient and family finances. Medical-Financial Partnerships (MFPs) are novel cross-sector collaborations in which health care systems and financial service organizations work collaboratively to improve health by reducing patient financial stress, primarily in low-income communities. Financial services provided by MFPs include individually tailored financial coaching, free tax preparation, budgeting, debt reduction, savings support, and job assistance, among others. MFPs have been shown to improve finances and, in the few existing studies available, health outcomes. We describe the rationale for MFPs and examine 8 established MFPs providing financial services under 1 of 3 models: full-scope on-site service partnerships; targeted on-site service partnerships; and partnerships facilitating referral to off-site financial services. The services MFPs provide complement clinical social risk screening and navigation programs by preventing or repairing common financial problems that would otherwise lead to poverty-related social needs, such as food and housing insecurity. We identify common themes, as well as unique strengths and solutions to a variety of implementation challenges MFPs commonly encounter. Given that the financial circumstances and health outcomes of socially marginalized patients and families are closely linked, MFPs represent a promising and feasible cross-sector service delivery approach and a new model for upstream health care to promote synergistic financial well-being and health improvement.",
keywords = "cross-sector partnerships, financial health, population health, social determinants of health",
author = "Bell, {Orly N.} and Hole, {Michael K.} and Karl Johnson and Marcil, {Lucy E.} and Solomon, {Barry S.} and Adam Schickedanz",
note = "Funding Information: Funding: Dr Schickedanz was funded for this work by 1) the UCLA National Research Service Award Primary Care and Health Services Fellowship, 2) the NIH/National Center for AdvancingTranslational Science (NCATS) UCLA CTSI, and 3) and the NIH/Eunice Kennedy Shriver National Institute of Child Health and Human Development. Funding Information: Overview: The targeted financial services MFP model embeds a specific type of financial service needed by the patient population into the clinic space. Often patients are identified through standardized screening questionnaires during clinical encounters, posted flyers in the clinic, during clinic appointment reminder phone calls, or word of mouth. Patients are provided the opportunity to receive financial services such as income support or tax services before or after clinic visits. This allows patients to maximize their time and receive services while coming to the clinic to see their medical team. An example of such an MFP is StreetCred at Boston Medical Center. The founders of StreetCred identified that many of their patients{\textquoteright} families qualified for the EITC and would benefit from on-site tax preparation assistance. StreetCred partnered with the Boston Tax Help Coalition, an Internal Revenue Service-sponsored Volunteer Income Tax Assistance (VITA) organization, to provide on-site tax preparation during the tax season. Volunteer tax preparers complete the tax returns of patient families while they see their clinic providers or at a separate time convenient for the family. Patients can then review, sign, and submit their tax return by the end of their clinic visit, saving the patients time and money. St. Michael's Hospital Income Security Health Promotion (ISHP) in Toronto refers patients likely to benefit from financial coaching and income support to income security health promoters, trained case managers and patient advocates focused on public benefit eligibility and financial issues. Referred patients work closely with health promoters to increase financial literacy and connect to public benefits and income supports for which they qualify. Patients and health promoters meet regularly during clinic appointments, or at times convenient for the patient, until financial goals are met. Keys to Success: Partnerships of this type emphasize the importance of identifying specific needs in patient populations. Both StreetCred and ISHP are currently working to expand the financial services provided to their patient populations. Having financial service professionals on-site was seen as an advantage for program efficiency, a way to maintain the fidelity of services, and an opportunity to continuously tailor services to patient and health system needs. Having space on-site significantly reduced barriers to patient/client engagement. Funding came from a mix of foundation grants, internal hospital grants, and corporate donations. ISHP is a program supported by the Ontario Ministry of Health and Long-Term Care. In order to decrease implementation costs, on-site targeted financial service programs often rely on volunteers in addition to paid employees. Funding Information: Funding: Dr Schickedanz was funded for this work by 1) the UCLA National Research Service Award Primary Care and Health Services Fellowship, 2) the NIH/National Center for AdvancingTranslational Science (NCATS) UCLA CTSI, and 3) and the NIH/Eunice Kennedy Shriver National Institute of Child Health and Human Development. Publisher Copyright: {\textcopyright} 2019 Academic Pediatric Association",
year = "2020",
month = mar,
doi = "10.1016/j.acap.2019.10.001",
language = "English (US)",
volume = "20",
pages = "166--174",
journal = "Academic pediatrics",
issn = "1876-2859",
publisher = "Elsevier Inc.",
number = "2",
}