Boosting the Sustainability of Community-Based Organizations

Our nation is in a time of change and transition when it comes to how health care services are delivered. Increasingly, health care providers have been looking beyond traditional clinical services to address other social determinants of health that impact individuals’ health, well-being, health care quality, cost and quality of life. Rather than reinventing the wheel, providers and payers are increasingly looking to community services providers for their expertise in supporting the health and wellness of older adults and people with disabilities.

This development brings unprecedented opportunities to bridge the gap between health care and LTSS. However, the pace at which these changes are occurring, as well as the organizational transformation that may be needed for this work, can be unsettling for the state and community-based organizations (CBOs) that are the backbone of the aging and disability networks across the country. CBOs are not only providing services to meet the needs of older adults, individuals with disabilities and their caregivers in their communities, but also developing business models that support their mission, ensure sustainable funding for the valuable services they provide and help payers (including the Centers for Medicare and Medicaid Services) to achieve quality goals and cost savings.

As challenging as these changes can be, the good news is they are providing opportunities that explicitly and directly support the mission and priorities of the Administration for Community Living (ACL), state disability and aging agencies and aging and disability CBOs. Successful partnerships between CBOs and integrated care entities help to promote self-determination and control; enable access to needed community-based long term services and supports (LTSS); and help alleviate confusion, stress, poor outcomes and higher costs among people with disabilities, older adults and their families who are navigating the service system. These activities lie at the heart of what aging and disability organizations do best—provide services and supports that allow people to live where and how they want.

CBOs Can Do This

During the last several years ACL has provided national leadership by preparing networks of state and community-based disability and aging organizations to demonstrate their value, and ultimately partner and contract with health care providers and payers through both broad-based and targeted technical assistance.

Between 2013 and 2016, through a public-private partnership with philanthropies such as The John A. Hartford Foundation, The SCAN Foundation, the Health Foundation of Western and Central New York and the Tufts Health Plan, with national and community-based organizations, ACL convened two learning collaboratives focused on building the business capacity of networks of CBOs to help them contract with integrated care entities to provide community-based LTSS. ACL and its contractors and grantees provided technical assistance in areas such as developing a value proposition, organizational culture change and more. These networks also offered aging and disability organizations the opportunity to come together in more formal networks that would allow them to achieve their common goals of building integrated service systems that are centered on individuals’ goals and preferences and powered by CBOs, and that can help to improve health outcomes and quality of life for the people they serve.

As of September 2016, the 20 learning collaborative networks had 28 signed contracts with integrated care entities such as health plans and systems, accountable care organizations, physician practices and hospitals, with many more under negotiation. The networks also worked to create structures to support their business operations (infrastructure, billing, finance, technology and more), whether it was a management services organization, a limited liability corporation, a brokerage model or another type of arrangement.

Further Investment

Since the inception of this work and the successes ACL has seen towards establishing integrated health care and social services delivery systems, building the business acumen of state and community-based aging and disability organizations has become a strategic priority for ACL.

As a result, new substantial investments have been made to improve the ability of disability and aging networks to take an active role in the development and implementation of integrated systems within their state. Grants totaling $3.75 million over three years were awarded to the National Association of States United for Aging and Disabilities, “Business Acumen for Disability Organizations” and the National Association of Area Agencies on Aging (n4a), “Learning Collaboratives for Advanced Business Acumen Skills” to build business capacity in the disability and aging services networks.

Other CBOs across the country are engaged and seeing value in these new opportunities.

  • The nonprofit Marin Center for Independent Living (MCIL) in San Rafael, CA has for nearly 38 years provided advocacy services to people with all types of disabilities, including older adults, to allow them to remain at home. A Success Story, produced by the American Society on Aging (ASA) as part of its work with the Aging and Disability Business Institute, features an in-depth interview with Eli Gelardin, MCIL Executive Director. In his own words, Gelardin describes the entrepreneurial mindset that MCIL adopted to grab hold of new opportunities to move the organization into the future in a smart and sustainable way.
  • In 2013, The SCAN Foundation (Foundation) developed Linkage Lab to provide capacity-building support to California CBOs that primarily serve older adults with chronic health conditions and functional limitations. Over a two-year period, six CBOs participated in Linkage Lab, gaining capacity-building skills and organizational transformation through regular seminars and on-the-ground technical expertise. The Foundation also provided modest financial support for critical infrastructure needs associated with developing contractual relationships with the health care sector. As of early 2015, the first Linkage Lab Cohort signed 27 contracts with health care providers with potential to serve more than 16,000 clients annually. Read a report of case studies showing the progress made and challenges faced toward achieving their goal of meaningful partnership with the health care sector.

Why Do This?

Crystal Lowe, former Executive Director of the Pennsylvania Association of Area Agencies on Aging and member of the ACL 2013-14 Business Acumen Learning Collaborative, has said, “This program has given me hope for our survival and our relevance. We are more efficient, we are more competitive, but we still have the individual at the heart of everything that we do.”

If nothing else, take home this message: change is scary, but can be the best part of the story as it can spur innovation and improvement. Embracing these changes, developing new partnerships, and building your business capacity can help you become better stewards of your resources (your margin) and thereby better serve the populations that are at the core of your mission.


-Lauren Solkowski is a Program Analyst in the Office of Integrated Care Innovations, Center for Integrated Care Programs, at the federal Administration for Community Living (ACL)