The increasing prevalence of value-based arrangements places providers at risk for not only cost, but also quality and outcomes. This movement from paying for activity to paying for results has forced providers in value-based arrangements to carefully consider factors such as cost, access, quality, care delivery efficacy and coordination throughout the entire continuum. With some estimates suggesting psycho-social factors and personal choices account for 70 percent of health outcomes, this outsized impact leads many to better understand the role of the Social Determinants of Health (SDOH) – food, housing, literacy, transportation, among others – and to ensure their inclusion in the continuum.
A 2011 Robert Wood Johnson Foundation survey of 1,000 primary care physicians found that while 85 percent felt SDOH directly contribute to health outcomes, four out of five were not confident they were able to meet SDOH needs, hurting their ability to deliver quality care. Further, 85 percent of physicians indicated patients’ SDOH needs are as important to address as their medical conditions and believe if given the option, one in seven prescriptions would be for SDOH.
This growing recognition of SDOH in health outcomes has motivated some health care organizations across the nation that work with high-need and vulnerable populations to pursue partnerships with community-based organizations (CBOs). Rather than re-invent the wheel, the growth of value-based arrangements has encouraged health care providers and payers to begin looking to CBOs for their expertise in supporting high-need and vulnerable populations in the community.
However, traditional health care providers and payers have historically had little incentive to collaborate with CBOs for a variety of reasons, including mis-aligned payment incentives as well as cultural and language barriers. While a number of efforts to link health care to broader social needs are emerging through many delivery and payment initiatives, these efforts are nascent and remain fraught with obstacles. The cross-sector relationships that are occurring are doing so under a variety of models, yet there is limited understanding of the strategic, cultural, operational and financial considerations that contribute to their success.
With support from philanthropic and advocacy organizations nationally, studies are underway to capture and share insights on these partnerships. Specifically, these studies are finding that successful partnerships that deliver value are built on five key factors:
Internal champions within the partner organizations:
Critical to overcoming organizational barriers and initial obstacles are opinion leaders within the partner organizations who serve as champions for the value of the partnership and the value of perseverance.
Strong working relationships among partner organizations:
Frequently not present at the beginning of the journey, representatives from partners organizations must build strong working relationships to create a “team” environment that fosters honesty, permits difficulties to be addressed and allows pursuit of commonly accepted, shared goals.
The partnership must be based on commonly accepted, shared goals that serve as the “true north” the member organizations are committed to pursuing. These goals can be reduced hospital re-admissions, lower nursing home placement, improved quality of life, enhanced cost profile among others. Regardless, the goals must be articulated, commonly accepted and outcomes clearly identified.
Partnership development requires not only courage and effort but also funding. Without commitment of appropriate financial support, the partnership is doomed to irrelevance or failure. Funding varies by community but can include Medicaid managed care organizations, health system contributions and state funds among other options.
The partnership thrives on honest, transparent sharing of data. The partners must select data points to be collected and analyzed in alignment of shared goals. Regular meetings must be scheduled to create an open forum for reviewing this information, honestly sharing areas of concern, identifying obstacles and resolving issues.
Even under the best circumstances, these partnerships are not without their challenges. Among these challenges are concerns that CBOs have the business acumen and capacity to bridge the service gap and help health care organizations (health systems, hospitals, and payers alike) to better control their quality and cost. CBOs are concerned that health systems are fully committed to a partnership that is at odds with a historical business mode built on volume. These concerns reflect resource, culture and language barriers and can be often be resolved by ensuring the key success factors above are addressed and monitored.
The movement from fee-for-volume to fee-for-value is at the foundation of the evolution in health care today. CBOs, payers and health care providers understand that to flourish in this new world will require partnership built on new business models, shared goals and transparent collaboration.