Together4Health: Integrating care for vulnerable populations

Dramatic changes in the design of payment and delivery arrangements for care of some of the nation's more vulnerable populations are being initiated at federal and state levels. This study analyzes early implementation of Together4Health, an innovative partnership among a diverse array of health and social services organizations in Chicago. The impetus for Together4-Health was a deliberate effort by policy makers to shift away from the fee-forservice system that rewards providers for delivering more services in an uncoordinated manner toward a system in which a range of services needed to care for a population is coordinated by organizations that are rewarded for efficiency and quality outcomes. Together4Health aims to deliver a full continuum of health and human services to the region's most costly Medicaid enrollees. Six key ingredients were identified as central to Together4Health's early viability: state-level contracting decisions, start-up fund availability, partner agreement about critical organizational design features, developing an IT infrastructure, establishing viable enrollment targets, and developing a sustainable financial model. Going forward, because the environment is changing and many of the innovations being implemented have a limited evidence base, it will be critical for Together4Health to learn quickly and rapidly adjust operating processes to ensure longer term success.