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Southeast Virginia has long been home to numerous early care and education programs. However, operating traditionally in siloes, these programs were not seeing the results they desired.
In 2016, Hampton Roads Community Foundation initiated a region-wide process involving nearly 100 stakeholders to scope and plan Minus 9 to 5, an initiative designed to unite previously disparate programs and people together for greater impact through systems change. This case study details the opportunities, highlights, and lessons learned in the first two years of the initiative.
Foundation for a Healthy Kentucky;
Creating a Culture of Health in Appalachia: Disparities and Bright Spots is an innovative research initiative sponsored by the Robert Wood Johnson Foundation (RWJF) and the Appalachian Regional Commission (ARC) and administered by the Foundation for a Healthy Kentucky. This multi-part health research project will, in successive reports: measure population health and document disparities in health outcomes in the Appalachian Region compared to the United States as a whole, as well as disparities within the Appalachian Region; identify "Bright Spots," or communities that exhibit better-than-expected health outcomes given their resources; and explore a sample of the Bright Spot communities through in-depth, field-based case studies. Taken together, these reports will provide a basis for understanding and addressing health issues in the Appalachian Region. This research initiative aims to identify factors that support a Culture of Health in Appalachian communities and explore replicable activities, programs, or policies that encourage better-than-expected health outcomes that could translate into actions that other communities can replicate.
This first report, Health Disparities in Appalachia, measures population health in Appalachia and documents disparities between the Region and the nation as a whole, as well as disparities within the Appalachian Region.
Pew Charitable Trusts;
Virginia's information analysis assists in determining needs, managing resources.
Mountain Empire is one of the newest of more than 100 independent PACE organizations across the nation that serve both as health plans and as medical and long-term service providers to elders—offering meals, checkups, rehabilitation services, home visits, and many other supports that enable enrollees to preserve their independence. The model for PACE dates back to 1971, when a public health dentist and social worker from the San Francisco Public Health Department working in Chinatown-North Beach noticed that as their clients aged, many needed extra support but dreaded moving into nursing homes. They founded On Lok Senior Health Services as an alternative to institutional care that would allow elders to "age in place" in their homes; on lokis Cantonese for "peaceful, happy abode."
On Lok's founders were particularly concerned about elderly clients who suffered when their various clinicians failed to work together, sometimes leading to complications that necessitated moves into institutional care. They designed On Lok to promote what was then an innovative approach: coordinating care from an interdisciplinary team of professionals who provide all primary care services and oversee specialists' services.
A Medicare-funded demonstration spanning 1979 to 1983 found this approach had many benefits. Care teams were able to prevent or quickly address problems, resulting in better health and quality of life and producing 15 percent lower costs than traditional Medicare. In the decades since, the model has spread slowly, though enrollment has grown nearly 40 percent in the past three years. As of January 2016, there were 118 PACE organizations in 31 states serving some 39,000 elders.
Health Care Cost Institute;
Children's Health Spending: 2010-2014 examines spending on health care for children covered by employer-sponsored insurance from 2010 to 2014. For the first time, HCCI analyzed children's health care spending trends at the state level, reporting on Arizona, Connecticut, Florida, Illinois, Maryland, Ohio, Texas, Virginia, and Wisconsin, as well as the District of Columbia.
Per capita spending on health care for children grew an annual average of 5.1% per year between 2010 and 2014, reaching $2,660 in 2014.
Rising prices were the chief driver of growth in spending for children's health care in 2014.
At the same time, there was a general decline in the use of health care services between 2012 and 2014.
Among the states studied, Arizona had the lowest per capita spending ($2,151 per child in 2014), while Wisconsin had higher per capita and out-of-pocket spending than the national average in every year studied – reaching $3,017 per capita in 2014.
Corporation for Enterprise Development (CFED);
The Assets & Opportunity Scorecard is a comprehensive look at Americans' financial security today and their opportunities to create a more prosperous future. It assesses the 50 states and the District of Columbia on 130 outcome and policy measures, which describe how well residents are faring and what states are doing to help them build and protect assets. The Scorecard enables states to benchmark their outcomes and policies against other states in five issue areas: Financial Assets & Income, Businesses & Jobs, Housing & Homeownership, Health Care, and Education.
World Resources Institute (WRI);
In August 2015, the U.S. Environmental Protection Agency (EPA) finalized the Clean Power Plan (CPP), the first-ever carbon pollution standards for existing power plants. The CPP builds on progress already under way to move the country toward a cleaner electricity system, including rapidly falling prices of renewables and increased deployment of moneysaving energy efficiency measures. The plan enables states to use a wide range of options to meet their standards, such as existing clean energy policies and power plants (the focus of this analysis), other tools to cut electricity use and increase the use of renewables, and broader initiatives such as participation in a capand- trade program or use of a carbon tax.
This fact sheet examines how Virginia can use its existing policies and infrastructure to meet its emission standards under the Clean Power Plan while minimizing compliance costs, ensuring reliability, and harnessing economic opportunities.
Volcker Alliance, The;
This report builds on the work of the State Budget Crisis Task Force, chaired by Volcker Alliance founder Paul A. Volcker and board member Richard Ravitch, from 2011 to 2014. In sounding the alarm, the task force warned that the cash-based budgeting practices most states and municipalities use facilitate "gimmicks and short-term measures that obscure actual financial conditions."
In this report, we revisited in more detail three states (California, New Jersey, and Virginia) of the six in the original study to learn if their budgetary practices were responding to the revenue growth provided by a recovering economy. The good news is that California has adopted a number of improved budgeting practices. That has helped the state win four upgrades of its general obligation from Moody's Investors Service, Standard & Poor's, and Fitch Ratings since 2013. Virginia, which has a history of more-careful budget management practices, has enacted substantial pension reforms but has struggled with underperforming revenues. In New Jersey, large gaps remain in pension and other programs.
A primary aim of this preliminary study is to lay the groundwork for a common approach toward responsible budget practices in all 50 states. A continuing comparative analysis should provide a framework for a scorecard with respect to budgeting and financing practices. By shining a spotlight on opaque and confusing practices and by identifying more-appropriate approaches, we hope to provide incentives for officials to clarify financial issues and encourage debate on basic policy choices. We hope to engage academic institutions in this effort by tapping their scholarly expertise, encouraging research on more-effective budgeting practices, and preparing more students for work in government budgeting at all levels.
Washington Area Women's Foundation;
This issue brief explaines how early care and education investments help prepare low-income children ages zero to five for kindergarten, a critical opportunity to increase readiness and close the achievement gap, provide an important work support for low-income working families and support the professional development and advancement of early care and education providers.
Transportation for America;
In 2015, Congress will once again debate transportation funding at the federal level. It would be in the best interests of the nation for them to fix the perpetual shortfalls in the Highway Trust Fund and set the country on a path toward a 21st century infrastructure. It is important to note that all of the states that have acted thus far, and those working to do so this year or beyond, are doing so in expectation of ongoing federal support.
Governors and legislators have acted because states face growing needs and static or falling revenues. The situation has been made worse by federal funding that has remained flat as costs have risen, and could grow disastrously worse should Congress reduce federal support in the upcoming renewal of the national program.
Regardless of what happens in Washington, states know that Congress will never appropriate enough support to close the gap needed to address maintenance backlogs and build for the future. Governors and legislators recognize that they can be leaders on this issue, working across party lines, generating new funding mechanisms, and creating new coalitions in support of transportation investment. The strategies and examples discussed in this report are intended to be a helpful guide for those emerging leaders as they navigate the unique context of their own individual states to pass transportation revenue legislation, and in turn, set an example for others to follow in the future.
This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.
By and large, Virginia opponents of the Affordable Care Act have been able to thwart full implementation at the state level. This can be seen in Virginia's decision to default to a federally facilitated marketplace and refusal to close the coverage gap. Having control of the executive branch and legislature until 2014 allowed lawmakers to minimize the impacts of the ACA, implementing only what was legally required of them and ignoring calls from advocates for low-income people who called for fuller implementation.
There remains the possibility for significant changes, including the structure and functioning of the marketplace as well as closing the coverage gap that would alter the state and national policy landscape. There remains serious debate about if and how Virginia will close the coverage gap. If Virginia moved forward, nearly 400,000 Virginians could get access to quality, affordable health care. Moreover, some advocates have asserted that Virginia could be the linchpin in opening up the South to Medicaid expansion.
Chesapeake Bay Foundation;
Information on the economic benefits of environmental improvement is an important consideration for anyone (firms, organizations, government agencies, and individuals) concerned about the cost-effectiveness of changes in management designed to achieve that improvement. In the case of the Chesapeake Bay TMDL (Total Maximum Daily Load of nitrogen, phosphorus, and sediment), these benefits would accrue due to improvements in the health, and therefore productivity, of land and water in the watershed. These productivity changes occur both due to the outcomes of the TMDL and state implementation plans, also known as a "Chesapeake Clean Water Blueprint" itself (i.e., cleaner water in the Bay) as well as a result of the measures taken to achieve those outcomes that have their own beneficial side effects. All such changes are then translated into dollar values for various ecosystem services, including water supply, food production, recreation, aesthetics, and others. By these measures, the total economic benefit of the Chesapeake Clean Water Blueprint is estimated at $22.5 billion per year (in 2013 dollars), as measured as the improvement over current conditions, or at $28.2 billion per year (in 2013 dollars), as measured as the difference between the Clean Water Blueprint and a business-as-usual scenario. (Due to lag times—it takes some time for changes in land management to result in improvements in water quality, the full measure of these benefits would begin to accrue sometime after full implementation of the Blueprint.) These considerable benefits should be considered alongside the costs and other economic aspects of implementing the Chesapeake Clean Water Blueprint.