April 2019: Time To Unmuddy The Waters


View this email in your browser


Vol 2 Issue 4

Dear friends,

If you’ve been to a meeting recently, you may have overheard exchanges like this…

“Social determinants of health”

“Don’t you mean ‘health-related social needs’?”

“Population health”  

“Ok, but don’t forget “community health.”


“For private investors, or for society’?”

Words matter. They reveal who we are: our values, our priorities. As we use words to drive change, those words also change us. They shape our sense of what’s expected and what’s possible. They help us understand and act on important, complex ideas.

But, as these exchanges indicate, words can also be frustrating when people from different backgrounds don’t share the same frameworks and definitions.

Now more than ever, we need to get clear about what we mean when we use terms like ‘social needs’ or ‘social determinants of health.’


Every week brings news of novel policy initiatives, partnerships, and collaboratives. Just last week, for example, CMS announced new payment models that will place primary care physicians at greater risk for patients’ health outcomes and, presumably, their health-related social needs as well. In the last few days, we also learned of multi-sector collaboratives fighting against structural racism, hospitals turning parking lots into homes, and future upstreamists learning how to prescribe food.

But just as healthcare, social service, and public health leaders come together, we’re using different words, terms, and definitions to describe our values and priorities related to social determinants of health. Sometimes we connect different meanings to the same word. Other times, we use different terms to convey similar meaning. This lack of clarity and precision in communication is muddying the waters, making it harder for us to collaborate rapidly and effectively, making it harder for us to move upstream.

It’s time to unmuddy the waters. In our April 24th webinar, in conversation with Kathryn Verlander of the Center for Medicare and Medicaid Services and Dora Hughes of Georgetown University, we presented a Toolkit to help do just that.

The Upstream Communication Toolkit has three components:

  • A Glossary of Upstream Terms that captures commonly used words and phrases that are regularly translated in clinical-community partnerships and multisector collaboratives.
  • A Levels of HRSN & SDH Integration Framework that helps convey the meaning of these terms in the context of day-to-day partnership development. Created with input from leading experts around the country, the Framework helps healthcare and social service partners view and apply the Glossary of Upstream Terms along a spectrum of opportunities, with basic service coordination to address HRSNs on one end of the spectrum to full system integration to address SDH on the other.
  • A Discussion Guide that not only helps partners clarify terms and meanings but also take on fundamental partnership challenges — like the need to balance financial and social returns and the potential for “medicalizing” social services. The Guide also provokes each partner to consider the role that each can play in addressing “the causes of the causes”, i.e. structural determinants like racism and income inequality.

These are hopeful times in health and human services, but they are also murky and complicated. We hope this toolkit helps to bring structure, organization, and clarity to the hard conversations we know are happening all around the county.

And, like the movement itself, the Toolkit is a work in progress. As we transform, as our language evolves, so will the Upstream Communication Toolkit. If you have comments on the Toolkit, thoughts or stories that could help shape this product, we’d love to hear from you.


Rishi Manchanda

HealthBegins is hiring!

We’re accepting applications for a generalist project manager with a proven track record successfully delivering on professional services engagements, preferably by working with cross-sector, remote teams in health or healthcare.

Please visit our website for the full job description, including application information.


From The Upstreamist, the HealthBegins Blog:

Upstreamist in Action: In a Texas Clinic, Lawyers Are Health Care Providers

Upstreamist in Action: When a patient at People’s Community Clinic in Austin, Texas, needs something more than routine care, her provider can refer her to the typical roster of specialists: a cardiologist, an orthopedist, a gastroenterologist. Plus one that’s far less typical: a lawyer.

Mincing Words: Making Sense of the Social Determinants of Health

With so many organizations getting interested in addressing the social determinants of health, the definitions can get muddy. In this recent interview and video with the Institute for Healthcare Improvement, HealthBegins founder Rishi Manchanda clarifies the meaning of this crucial work and connects it with pursuit of the Triple Aim and joy in work.

New Hope, Timeless Values: What Happened When HealthTech 4 Medicaid Went to Church

The HealthBegins team went to San Francisco this month to join the 2nd Annual Future of Medicaid Innovation Forum. In a church with a historic past, we sat in fellowship with hopeful, determined entrepreneurs working to improve Medicaid through tech. Our post explains what we saw, learned, and will carry with us.

Watch Our April webinar!


Unmuddy the Waters: How Healthcare and Social Sector Partners are Improving Communication on the Journey Upstream

As more organizations forge clinical-community partnerships and join multi-sector collaboratives to address social determinants of health, we’re seeing healthcare, social service, and public health stakeholders use different words, terms, and definitions. This lack of clarity and precision in communication is muddying the waters, making it harder for partners to move upstream rapidly and effectively. In this webinar, national leaders in the upstream movement will share lessons from the frontlines of implementation and policy. They will highlight ways stakeholders in multi-sector collaboratives and clinical-community partnerships can better communicate about social determinants of health and health equity.

Watch Our April Webinar

Links to the resources we mentioned during the webinar:

HealthBegins Upstream Communication Toolkit 

AHC Website

Funders Forum for Accountable Health 

If you’d like to talk to HealthBegins about ways we can help you address what was in this webinar, please email us at info@healthbegins.org.

Interested in more webinars from HealthBegins? You can find recordings of all of our past webinars here.

Upcoming Events: Find HealthBegins Here

The Community HealthCare Association of the Dakotas Members Conference
May 7 | Fargo

Community healthcare center professionals and leaders gather to learn from experts and each other.

SGIM 2019 Annual Meeting
May 9 | Washington, DC

This meeting will be an opportunity for attendees to discuss how to advance health equity whether in the hospital, the clinic, the classroom, or the laboratory.

The Alliance Annual Seminar
May 21 | Madison

Attendees will explore what primary care is and how to incorporate value into high-value primary care.

Presenting powerful upstream results at an upcoming conference? Nominate yourself to be featured as a HealthBegins Upstreamist in Action at info@healthbegins.org.

Upstream News

Curated highlights of happenings affecting upstream care. Links are not endorsements.

Patients come first – Dr. Rishi Manchanda (Podcast)
Virginia Hospital & Healthcare Association

Punishing and toxic neighborhood environments independently predict the intergenerational social mobility of black and white children

Workplace wellness programs study: final report
PubMed Central (PMC)

Brad Paisley and wife Kimberly break ground on free grocery
Scary Mommy

The proudest day of Grace’s life was graduating as a doctor. Then she began treating patients | Isabel Hanson and Safdar Ahmed
The Guardian

Copyright © *|CURRENT_YEAR|* *|LIST:COMPANY|*, All rights reserved.


Our mailing address is:


Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list.



Featured Content

Staff Spotlight: Erica Jones, Following Her Path and Passion to Help People

“I wish people would try to advocate for themselves more, because I feel like there's this power struggle and people don't feel like they can.”

Staff Spotlight: Kyron Pierce, The Eagle Scout with a Passion For Helping People Lead Healthy Lives

“[Health equity] is very hard work and it might be some years for us to see the fruits of our labor, but it'll be worth it when you do produce it.”

Staff Spotlight: Alejandra Cabrera, Perfectly Imperfect Artist and Health Equity Advocate

When I work with people and communities, I always think back to this sense of not belonging and it drives me to continue to do the heart-work we need to do to advance health equity.