Health plans, healthcare providers, and community-based organizations (CBOs) are increasingly partnering to deliver home- and community services to older adults, many of whom have chronic health conditions or disabilities.
These partnerships can be game changers, especially as more organizations are screening for social needs.
Health plans also understand that unmet social needs play a large role in health disparities and preventable costs.
Overcoming Community-Based Organization Obstacles
Managed care organizations are increasingly offering services that address health-related social needs, such as home-delivered meals, home modifications, and transportation services. This can include Medicare Advantage supplemental benefits and Medicaid value-added services.
However many CBOs report that it is difficult to enter into contracting relationships with the healthcare sector.
For example, health plans have had concerns about contracting with CBOs due to obstacles including establishing a clear scope of services, geographic coverage, and/or billing and payment issues.
As a result, many CBOs have developed new capacities to better partner with payers and providers, either individually or with community care hubs, to make contracting processes easier.
Community-Based Organization Partnerships: Opportunities to Create Value
There are five key reasons health plans should partner with CBOs, according to a joint report from the U.S. Aging, Aging & Disability Business Institute, Partnership to Align Social Care, and the Camden Coalition:
1. Powerful Innovation Partners
CBOs have the expertise and infrastructure to connect health plans to key social care partners and programs. This includes established staffing, workflows, and relationships that can be deployed on behalf of plans to efficiently provide services that address member needs, and help create new solutions that bridge health and social care.
2. Build Trust with Members
CBOs can foster a local presence and engender trust with members that can strengthen a health plan’s reputation and enhance market share.
Health plans recognize that trust is critical in engaging and retaining members, particularly those who face complex health and social needs. While most health plans operate on a statewide or national capa
city and often lack a local presence, CBOs are trusted local stakeholders in the communities they serve. They have strong relationships with community groups, like faith communities, schools, and neighborhood institutions, and hire staff and board members directly from the community.
3. Return on Investment
Social care interventions produce health care savings and service delivery value for health plans.
There is an opportunity for CBOs to produce a significant return on investment by linking members to available community social care, and meeting (or exceeding) accreditor and evaluator measures.
According to the Aging and Disability Business Institute’s 2021 CBO–Health Care Contracting Survey, more than 40% of CBOs with health care contracts provide SDOH screening and care management to healthcare providers and payers.
4. Efficiency in Coverage
Partnering with CBOs can provide greater efficiency in coverage and social care contracting. In addition, community care hubs (CCH) can help scale
and standardize services to health plans while minimizing transaction and contract management costs.
As health plans incorporate social care benefits as a core service area, they need to develop a parallel provider network. Many CBOs are experts in service delivery and enjoy deep community connections and trust, but lack the operational infrastructure to partner with highly regulated health plans.
CCHs enable a wider range of CBOs to participate in healthcare partnerships by providing shared administrative services such as business development, contracting, compliance and data security, data reporting, billing and coding, and quality improvement to their network.
5. Securing Public Contracts
CBO partnerships help health plans compete for contracts and improve market share in publicly funded insurance.
An analysis of Medicaid requests for proposals demonstrates that states heavily weigh innovative implementation and management of programs related to member services and population health, such as social determinants of health (SDOH) and health equity initiatives when awarding contracts to plans.
A history of productive engagement and contracts with CBOs can make health plans more competitive in Medicaid RFPs by demonstrating their commitment to local partnership, member experience, innovation in whole-person health and SDOH, and health equity.
What are Community Based Organizations?
CBOs are the backbone of many communities, providing much-needed services and support to people in need. They can be public or private not-for-profit resource hubs that provide specific services to the community or to a targeted population within the community. They are trusted entities that know their clients and their communities, want to be engaged, and may have systems in place to help coordinate activities or distribute timely and accurate information.
What Types of Services do CBOs Include?
CBOs include but are not limited to aging and disability networks, community health centers, childcare providers, home visiting programs, state domestic violence coalitions and local domestic violence shelters and programs, adult protective services programs, homeless services providers, and food banks that work to address the health and social needs of populations.
What are Community Care Hubs?
These are community-focused entities supporting a network of CBOs and providing services addressing health-related social needs. Community care hubs centralize administrative functions and operational infrastructure.
What Role do Community Based Organizations Play in Community Development?
CBOs tend to serve as the middleman for resources and actions. Many larger groups, like non-profits and intersecting communities, use CBOs as a way to interact with those who are already at work on issues within the community. An established CBO can attract and filter resources, including volunteers.
More health plans are looking to CBOs to address the health-related social needs of older adults, reduce health disparities, prevent unnecessary hospitalizations, and help people remain in their homes as long as possible.
CBOs are essential partners as health plans work to make this a reality for their members. These organizations have the trust of communities, service expertise, and the infrastructure to help health plans achieve their health equity, quality, and financial goals.
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