Health Care Outreach Toolkit

Purpose of This Toolkit

This toolkit offers guidance for aging and disability community-based organizations (CBOs), such as Area Agencies on Aging (AAAs) and Centers for Independent Living (CILs), that are in the early stages of seeking to contract with health care providers and payers to provide home and community-based services and supports. CBOs at various stages of contracting with health care entities can use this toolkit as a primer on how to conduct outreach and how to craft messages best suited to potential contracting targets.

Why is Outreach Important?

If you don’t brag about your CBO’s skills, competencies and successes, who will? Trusting chance to be your messenger is not something to build a business plan on.

In the health care payer and provider worlds, there is a lack of understanding regarding CBOs and their capabilities. If a health care entity doesn’t know how your CBO can help it meet its goals, it is likely to build a solution of its own, thus competing with the services your CBO provides and missing out on the valuable experience and expertise your CBO has built over time.

Communicating clearly and effectively about your CBO’s capabilities removes one of the biggest barriers to health care contracting and builds stronger business alliances, potentially leading to successful cross-sector partnerships and healthier communities.

How to Use This Toolkit

This Toolkit is designed to help CBOs identify the specific audiences and messages needed to attract several types of potential health care entities as partners. Every market is different, and these messages should be tailored to represent your CBO’s unique needs, strengths and opportunities.

Step 1: Identify your goal.

What is your CBO trying to achieve? How will you define success? Which business line(s) do you want to grow? Which health care payer(s) and/or provider(s) do you want to do business with? Knowing specifically which types of health care entities your CBO is best positioned to work with or what you want from a business relationship is the first step. See the Appendix for useful tools that can help your CBO define its goals.

Step 2: Determine Your Potential Partner(s)

Once your CBO has identified its health care contracting goals, you need to determine which potential business partner(s) can help you achieve those goals. Conducting a thorough market analysis will help you identify and prioritize potential health care partners in your market. The Aging and Disability Business Institute’s Market Assessment and Opportunity Assessment tools can help guide your organization through these processes. Using an assessment tool provides an organized approach to what can seem to be a confusing or daunting process. These tools were developed to help your CBO identify proper targets more accurately.

Step 3: Inventory Existing Relationships with Target Partner(s)

Relationships are essential to health care contracting work. As such, your CBO will want to identify and inventory connections that your CBO may have with its target partner(s) that will allow it to build and strengthen those relationships. Consider the following:

  • Has your CBO worked with the target partner in the past?
  • Does anyone affiliated with your CBO (e.g., a staff member, board member or volunteer) have a connection to an employee of your target organization? These can be any kind of connections, including from professional and community groups (e.g., schools, Kiwanis, Rotary, Chamber of Commerce, faith-based institutions or groups, etc.).
  • Does any of the leadership at the target health care entity donate to your CBO?
  • Are there political connections, industry associations or community members who might be willing to open a door for you with your target organization?

Look for all the potential relationships that currently exist between your CBO and your target partner. Once you’ve compiled that list, begin to prioritize them in terms of access to decision-makers within the target organization.

Step 4: Dig for Background

You’ve figured out what you want to achieve. You’ve identified target health care entities that can help your CBO meet that goal. You’ve inventoried existing connections. Now you need to understand how your CBO can help your target partners achieve their goals.

Often, one of your connections may have knowledge of your target organization’s goals and can share that information. Asking questions directly of your target is never a bad thing—especially if you make it clear you might be able to help them as a potential partner. Remember what we said above about relationships, asking these questions can help to continue to build and strengthen your relationship with your target partner. Demonstrating an interest in your target partner’s success, and what keeps them up at night in serving their members/patients, will also help your CBO show that it understands your target’s goals and interests—and will help your CBO craft its messages and value proposition.

Step 5: Apply the Information from this Toolkit

The following sections provide additional guidance about potential target partners for your CBO and will help identify the right person or audience at each target organization and how to shape appropriate messages about your CBO to start a conversation and win business. Based on the information gleaned by completing the previous steps, your CBO should tailor its messages to fit its strengths and capacities as well as your contracting target’s needs, challenges and pain points.

  • Medicare Advantage Plans
  • Medicaid Plans
  • Commercial Insurance Plans (including employer-sponsored and marketplace plans)
  • Accountable Care Organizations
  • Health Systems
  • Hospitals
  • Medical Practices

These sections will also identify unique messages for each of these seven market segments. Based on the information gleaned by completing the previous steps, messages should then be tailored to fit your organization’s strengths and capacities as well as your contracting target’s needs, challenges and pain points.

Core Messages

The following messages are central to describing the value that CBOs can bring to a potential health care contracting partner and can be useful when opening conversations with potential target partners. The following messages will resonate more or less with depending on the type of personnel with whom you are communicating (e.g., administrative staff, medical staff or finance staff).

Administrative staff are those likely to be in decision-making roles. Medical staff are individuals who are likely to be consulted on the medical or health value of a CBO’s services. And finance staff are those likely to be asked for input regarding the financial value of contracting with a CBO for services.

These messages focus on the most important information your CBO is likely to communicate. However, you should modify them to best fit the needs of your target and highlight your CBO’s expertise. Always add detail—data about results you’ve achieved, stories about clients you’ve helped, and possible return on investment (ROI) if a health care partner contracts with your CBO.

Message

Admin

Medical

Finance

We can provide the right care and supports in the right place at the right time—meeting needs and reducing unnecessary spending.  🗸 🗸  
We can help health care organizations achieve their goals based on our experience. Tip: Here is another area where doing your homework will be important. Being able to connect your CBO’s services and experience to a health plan’s contracts with your state or with CMS—where it has potential incentives or penalties—can strengthen your CBO’s business case. 🗸 🗸 🗸
Partnering with us for service provision can help reduce health care utilization and produce cost savings. 🗸   🗸
Our services can help your organization achieve better quality measures. Tip: Include specific measures that your CBO’s services can potentially influence.1 🗸 🗸 🗸
Our services can help your organization achieve improved member satisfaction and experience scores and improve retention. 🗸    
Our cost profiles tend to be lower as this is our core business. It is more cost-effective to purchase these services from us. 🗸   🗸
Our services can give your organizations a sales advantage—both in attracting members and retaining members. Tip: Member retention is key. Health care entities don’t want to invest in prevention, assessment and a service plan only to have members leave them for another plan (called “churn”). The longer a member stays with a plan, the more likely they are to see the outcomes of service plans, etc. Churn is expensive for health plans and they want to prevent it whenever they can. 🗸   🗸
We are based in the communities where your members/patients live. We have established community relationships, trust and cultural competence that we bring to our services that health care entities may not. Tip: Different health care organizations call the people they serve different names. At hospitals, health systems and medical practices they’re called patients; at health plans they’re called members. Do your homework to learn more about who your target partner serves and what they call them. 🗸 🗸  
Our CBO is embedded in the community, allowing us to develop relevant cultural competence and know our community’s needs. 🗸    
We have proven outcomes. Tip: Integrating your agency’s program results will be important in your messaging here—whether that is data you have on reductions in hospital readmissions or Emergency Department usage, or other program impacts. Also, being able to show Return on Investment to a potential target partner can go a long way to making the case for them to contract with your agency. 🗸 🗸  
We can help fill gaps in addressing social determinants of health needs. 🗸 🗸  
Our services can give your organization a sales advantage—both in attracting members and retaining members.    🗸  

Additional Guidance

     
Be sure to discuss not only your CBO’s experience in service provision but also its experiences providing services to communities of which their members/patients are a part and other qualifications that make your CBO a good business partner. These can include accreditation from different accrediting bodies such as the National Committee for Quality Assurance (NCQA) and Commission on Accreditation of Rehabilitation Facilities (CARF), your privacy and security standards, compliance procedures and more.
If your CBO is part of a network of CBOs, highlight that relationship (and connect the contracting organization to your network lead entity, if that is not your organization). Networks can provide broader geographic coverage, serve more people and have greater efficiency when it comes to contracting and associated administrative functions.

Finally, your CBO can be more than just a vendor to a health care organization; it is an important partner in meeting the holistic, person-centered home and community-based services (HCBS) needs of the older adults and people with disabilities whom they serve. That is an important sales point that should be part of your conversations and messaging.


 

1 National Association of Area Agencies on Aging, Aging and Disability Business Institute, Health Care Quality Metrics and Measures. https://www.aginganddisabilitybusinessinstitute.org/adbi-resource/health-care-quality-metrics-and-measures/

 

What is Medicare Advantage and How Does it Work?

Medicare Advantage (MA) plans are health plans offered by private companies under contract with Medicare to provide Medicare Part A and Part B coverage. Most MA plans, sometimes referred to as Medicare Part C, also include drug coverage (Medicare Part D).1

Medicare pays a fixed amount for a member’s coverage each month to the company offering the MA plan. Companies that offer MA plans must follow rules set by Medicare. Each year MA plans can update their premiums, the rates they charge for out-of-pocket costs and rules for how services are provided (e.g., healthy groceries for people with prescribed diets or air conditioners for people with asthma). The plan must notify members/beneficiaries about any changes before the start of the next enrollment year.2

Since changes to offerings can happen each year, your CBO needs to pay attention to any proposed or actual changes and determine how they may impact the specific services your CBO might market and sell to that plan.

MA plans cover all Part A and Part B services. Some may also offer additional supplemental benefits. Of interest to CBOs is that many MA plans now offer coverage for services that address the social determinants of health, which original Medicare does not cover. These may include services related to housing, transportation, education, social isolation and others—usually addressing factors that affect access to care, health care utilization and outcomes.3

Because there are many types of MA plans, it is critical that your CBO take the time to learn about the structure, priorities and needs of its MA plan target partners. Each MA plan type has special rules about how it covers Part A and B services as well as each plan’s supplemental benefits.

An online tool from the Centers for Medicare & Medicaid Services (CMS) can help your CBO identify which MA plans are available in your state or service area. CBOs can also use the Find a Medicare Plan tool to find information on plans, including the services they offer and each plan’s Star Ratings, which can help your CBO identify potential areas of need that it can address.4,5

Learn more about which services CBOs are providing under contract with ACOs in this data brief from Scripps Gerontology Center that summarizes findings from the 2020 Aging and Disability Business Institute CBO–Health Care Contracting RFI Survey.6

 

Outreach Targets at Medicare Advantage Plans

By this point in the process, your CBO should have inventoried its existing relationships and identified connections that can facilitate discussions with potential partners. If no such relationships exist, making cold calls to the outreach contacts listed below at the plan is another option.

See the Business Institute’s blog post, Lessons Learned from the Trailblazers Learning Collaborative: Steps to Getting Started on Health Care Contracting, for more information about beginning your outreach to a potential health care partner.7

The following are the titles/roles of individuals at a plan who are most likely to have some say in arranging contracts with CBOs. Target audiences within a MA plan may use different titles.

  • Regional leaders (i.e., Market President, Regional Leader)
  • Head of Case Management/Utilization Management
  • Product Management
  • Clinical Operations personnel

The following are the titles/roles of individuals who are most likely to be brought in at later stages of contractual discussions. If your CBO has a connection to individuals on this list, they may be useful to speak with in opening doors to the above-mentioned contacts.

  • Chief Transformation Officer
  • Vice President/Senior Vice President of Network Partnerships or Network Development
  • Vice President/Senior Vice President of Senior Markets
  • Growth/Strategy Directors
  • Chief Innovation Officer
  • Quality Management
  • Population Health
  • Clinical Integration Manager
  • Regional Care Management lead
  • Chief Nursing Officer
  • Chief Medical Officer
  • Disease Management staff
  • Quality Management staff
  • Chief Financial Officer
  • Risk Adjustment Manager

Messaging to MA Plans

Your strongest message will be one that connects the services your CBO provides with how it will help your target MA plan partner achieve its goals, overcome challenges and serve its members. If you’ve conducted research or worked with your target Medicare Advantage plan before, you may already know what is needed. The objective is to do your best to identify where your CBO’s services fit the plan’s needs before initiating a discussion.

In addition to the core messages your CBO has chosen to use, the following messages may be useful in subsequent conversations. As with core messages, CBOs should customize these messages to highlight their particular experience and success.

  • We can help make sure your members’ Hierarchical Condition Categories (HCCs) are captured, which help get a higher rate of reimbursement.8
    • Tip: Health plans have to spend a certain amount of their premium dollars on beneficiary care and quality improvement activities. The ratio of that amount to what they spend on administrative costs is called the Medical Loss Ratio.9 Relating the services your CBO can provide under contract to Medicare codes for beneficiary services and how they will impact a plan’s Medical Loss Ratio will help make the case for you.
  • Our services can give your health plan a sales advantage—both in attracting and retaining members.
  • Churn in the marketplace may be expensive. We can help your organization with member retention.

1 Centers for Medicare & Medicaid Services, Medicare Advantage plans, https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans

2 Centers for Medicare & Medicaid Services, How do Medicare Advantage Plans work? https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work

3 National Association of Area Agencies on Aging, Aging and Disability Business Institute, Policy Spotlight: New Federal Law and Rules Open Door for Integrated Care in Medicare Advantage, https://www.aginganddisabilitybusinessinstitute.org/wp-content/uploads/2018/07/Policy-Spotlight-Integrated-Care-print.pdf

4 Centers for Medicare & Medicaid Services, MA Contract Service Area by State/County, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/MA-Contract-Service-Area-by-State-County.

5 Centers for Medicare & Medicaid Services, Find a Medicare plan, https://www.medicare.gov/plan-compare/#/?lang=en&year=2021

6 Scripps Gerontology Center of Excellence, Strengthening Ties: Contracting Between Community-Based Organizations and Health Care Entities, https://www.aginganddisabilitybusinessinstitute.org/adbi-resource/strengthening-ties-contracting-between-community-based-organizations-and-health-care-entities/.

7 National Association of Area Agencies on Aging, Aging and Disability Business Institute, Lessons Learned from the Trailblazers Learning Collaborative: Steps to Getting Started on Health Care Contracting, https://www.aginganddisabilitybusinessinstitute.org/lessons-learned-from-the-trailblazers-learning-collaborative-steps-to-getting-started-on-health-care-contracting.

8 AAFP, Hierarchical Condition Category Coding. https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/hierarchical-condition-category.html.

9 National Association of Area Agencies on Aging, Aging and Disability Business Institute, Changes to Medicare Advantage Reinforce the Role of CBOs in Supplemental Benefits. https://www.aginganddisabilitybusinessinstitute.org/changes-to-medicare-advantage-reinforce-the-role-of-cbos-in-supplemental-benefits/.

What is Medicaid and How Does it Work?

Medicaid is government-run health insurance coverage for people with limited incomes. Though Medicaid has federal requirements, it is administered by states. It is jointly funded by states and the federal government and is called by different names in different states.1

Enrolling over 72 million Americans, Medicaid is the single largest health care payer in the U.S. as well as the biggest payer for long-term services and supports (LTSS). More than half of LTSS spending is on home and community-based services (HCBS) that help allow older adults and people with disabilities to live in their homes and communities rather than institutions. Older adults and people with disabilities represent approximately a quarter of Medicaid enrollment but account for almost two-thirds of spending.2

Individuals who qualify for Medicaid receive a medical card and benefits that can be used in the same way as health insurance coverage through any other insurer. Some individuals who are eligible for Medicaid coverage may also have coverage from Medicare. As a means-tested program, federal law requires that Medicaid be considered the payer of last resort.3 Medicaid provides complete coverage for most medical expenses and does not require payment of premiums or deductibles.

Medicaid provides complete coverage for most medical expenses and does not require payment of premiums or deductibles. In addition, health care providers who accept Medicaid cannot bill patients for any additional charges after Medicaid has adjudicated the claim, as they can with Medicare. To learn about the services that Medicaid plans can offer, take a look at Medicaid’s list of mandatory and optional medical benefits.4

Some states’ Medicaid programs pay for care directly while other states use private insurance companies to provide Medicaid coverage. This is called Medicaid managed care. Medicaid managed care is intended to control costs and utilization while ensuring quality. This makes Medicaid managed care plans a good potential target for messages that communicate a CBO’s ability to contribute to cost savings. Medicaid managed care is delivered by managed care organizations (MCOs) under contract with state Medicaid agencies.5

Some states have launched initiatives that seek to coordinate and integrate care under Medicaid managed care. These initiatives are focused on improving care for populations with chronic and complex conditions, aligning payment incentives with performance goals and promoting high quality care. For data about Medicaid managed care enrollment, access and contract requirements, visit the Kaiser Family Foundation’s Medicaid managed care Market Tracker.6 Your CBO can also access a list of Medicaid MCOs and their parent companies via Kaiser Family Foundation.7 This may help your CBO identify the corporate structure and specific role of your target audience(s) as you identify your outreach targets.

Learn more about which services CBOs are providing under contract with Medicaid plans in this data brief from Scripps Gerontology Center that summarizes findings from the 2020 Aging and Disability Business Institute CBO–Health Care Contracting RFI Survey.8

 

Outreach Targets at Medicaid Plans

When preparing to connect with a Medicaid plan, CBOs should first determine whether they provide services the plan needs. Your state’s Medicaid agency (again, called different names in different states) will have information about specific objectives and key staff of the program. It should also have information regarding Medicaid managed care programs that may be offered in your state. Since those programs are tasked with managing cost, utilization and quality associated with the provision of Medicaid services to state residents, they will likely be your best opportunity for contracting your services.

The next step is to determine how your CBO’s value proposition addresses the needs of your Medicaid plan target. By this point in the process, your organization should have inventoried your CBO’s existing relationships and identified connections that can facilitate discussions with a potential partner. If no such relationships exist, making cold calls to the outreach contacts listed below at either your state Medicaid agency or a specific plan is another option, but it is always better to be introduced through a trusted partner.

See the Business Institute’s blog post, Lessons Learned from the Trailblazers Learning Collaborative: Steps to Getting Started on Health Care Contracting for more information about beginning your outreach to a potential health care partner.9

The following are the titles/roles of individuals who are most likely to have a say in arranging contracts for work, at either your state’s Medicaid agency or a specific Medicaid managed care plan.

  • Director of Medicaid Services
  • Associate Director, Value-Based Purchasing
  • Associate Director Program Management
  • Regional leaders (i.e., Market President, Regional Leader)
  • Head of Case Management/Utilization Management
  • Product Management
  • Clinical Operations personnel

The following are the titles/roles of individuals who are likely to be brought in at later stages of contractual discussions. If your organization has a connection to individuals on this list, they may be useful to speak with in opening doors to the above-mentioned contacts.

  • Chief Transformation Officer
  • Vice President/Senior Vice President of Network Partnerships and Network Development
  • Vice President/Senior Vice President of Senior Markets
  • Growth/Strategy Directors
  • Chief Innovation Officer
  • Quality Management
  • Population Health
  • Clinical Integration manager
  • Regional Case Management lead
  • Chief Nursing Officer
  • Chief Medical Officer
  • Disease Management staff
  • Chief Financial Officer

Messaging to Medicaid Plans

Your strongest message will be one that connects the services your CBO provides with how your CBO will help the state or plan achieve a goal, overcome a challenge or serve its residents/members. If your CBO has conducted research or worked with the target Medicaid managed care plan before, you may already know what is needed. The objective is to do your best to identify where your services fit the plan’s needs before initiating a discussion.

In addition to the core messages your CBO has chosen to use, the following messages may be useful in subsequent conversations. As with core messages, CBOs should customize these messages to highlight their particular experience and success.

  • We can address the needs of any age member or patient.
  • We are better able to locate and address the needs of often hard to find patients.
  • We can provide case management and a range of home and community-based services (HCBS). Tip: This message is especially effective in states where costly institutional care outweighs HCBS.)
  • Our services can give your health plan a sales advantage—both in attracting and retaining members.
  • Churn in the marketplace may be expensive. We can help your organization with member retention.

1 Unites States Department of Health and Human Services, What is the Medicaid program? https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-medicaid-program/index.html.

2 Kaiser Family Foundation, 10 Things to Know about Medicaid: Setting the Facts Straight, https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/.

3 Centers for Medicare & Medicaid, Deficit Reduction Act Important Facts for State Policymakers, https://www.cms.gov/Regulations-and-Guidance/Legislation/DeficitReductionAct/downloads/tpl.pdf.

4 Centers for Medicare & Medicaid Services, Mandatory & Optional Medicaid Benefits, https://www.medicaid.gov/medicaid/benefits/mandatory-optional-medicaid-benefits/index.html.

5 Centers for Medicare & Medicaid Services, Managed Care Entities, https://www.medicaid.gov/medicaid/managed-care/managed-care-entities/index.html.

6 Kaiser Family Foundation, Medicaid Managed Care Market Tracker, https://www.kff.org/data-collection/medicaid-managed-care-market-tracker/.

7 Kaiser Family Foundation, Medicaid MCOs and their Parent Firms, https://www.kff.org/other/state-indicator/medicaid-mcos-and-their-parent-firms.

8 Scripps Gerontology Center of Excellence, Strengthening Ties: Contracting Between Community-Based Organizations and Health Care Entities, https://www.aginganddisabilitybusinessinstitute.org/adbi-resource/strengthening-ties-contracting-between-community-based-organizations-and-health-care-entities/.

9 National Association of Area Agencies on Aging, Aging and Disability Business Institute, Lessons Learned from the Trailblazers Learning Collaborative: Steps to Getting Started on Health Care Contracting, https://www.aginganddisabilitybusinessinstitute.org/lessons-learned-from-the-trailblazers-learning-collaborative-steps-to-getting-started-on-health-care-contracting/.

What Is Commercial Health Insurance and How Does it Work?

Commercial health insurance is typically offered by for-profit companies, though there are nonprofit organizations that provide this insurance. Monthly premiums paid by policy holders provide the resources to fund commercial policies, with a balance between premiums and coverage amounts creating a profit for the insurance provider. Most employer-provided group health insurance policies are commercial, as are individual policies available to individuals who do not have access to employer-sponsored plans. Commercial health insurance plans are federally regulated but are also subject to state regulations. Because of this, commercial health insurance plans and companies vary greatly from state-to-state.

There are many different types of commercial health insurance. The following are the most common:

  • Health Maintenance Organization (HMO): HMOs often have the lowest premiums and out-of-pocket costs, but they offer fewer choices as members are required to stay within a network of services, the exception being in an emergency.
  • High-Deductible Health Plan: A high-deductible health plan charges a higher deductible than most other health plans. Designed for healthy individuals not anticipating health care expenses with the ability to pay a large deductible should a medical emergency arise.
  • Preferred Provider Organization (PPO): PPOs rely on a network of physicians and offer members a degree of choice and flexibility. Copays are lower for in-network providers with a larger portion of services covered.
  • Point-of-Service Plan: This combines elements of both HMO and PPO plans.
  • Private Fee-For-Service: This is a type of plan administered by a private company.

Learn more about which services CBOs are providing under contract with commercial health insurance plans in this data brief from Scripps Gerontology Center that summarizes findings from the 2020 Aging and Disability Business Institute CBO–Health Care Contracting RFI Survey.1

 

Outreach Targets at Commercial Health Insurance Plans

When preparing to connect with a commercial health insurance plan, consider how your organization can help a commercial health insurance plan meet its goals. Determining this can involve simple research on your state’s health department website to learn about its specific objectives and identify individuals involved in managing the program.

The next step is to determine how your CBO’s value proposition addresses the health plan’s needs. By this point in the process, your CBO should have inventoried its existing relationships and identified connections that can facilitate discussions with a potential partner. If no such relationships exist, making cold calls to the outreach contacts listed below is another option, but it is always better to be introduced through a trusted partner.

See the Business Institute’s blog post, Lessons Learned from the Trailblazers Learning Collaborative: Steps to Getting Started on Health Care Contracting, for more information about beginning your outreach to a potential health care partner.2

The following are the titles/roles of individuals at a specific commercial health insurance plan who are most likely to have say in arranging contracts for work.

  • Regional leaders (i.e., Market President, Regional Leader)
  • Head of Case Management/Utilization Management
  • Product Management
  • Clinical Operations personnel

The following are the titles/roles of individuals who are likely to be brought in at later stages of contractual discussions. If your organization has a connection to individuals on this list, they may be useful to speak with in opening doors to the above-mentioned contacts.

  • Chief Transformation Officer
  • Vice President/Senior Vice President of Network Partnerships and Network Development
  • Vice President/Senior Vice President of Senior Markets
  • Growth/Strategy Directors
  • Chief Innovation Officer
  • Quality Management staff
  • Population Health staff
  • Clinical Integration Manager
  • Regional Case Management lead
  • Chief Nursing Officer
  • Chief Medical Officer
  • Disease Management staff
  • Chief Financial Officer

Messaging to Commercial Health Plans

Your strongest message will be one that connects the services your CBO provides with how your CBO will help the plan achieve a goal, overcome a challenge and serve its members. If you’ve conducted research or worked with your target plan before, you may already know what is needed. The objective is to do your best to identify where your services fit the plan’s needs before initiating a discussion.

In addition to the core messages your CBO has chosen to use, the following messages may be useful in subsequent conversations. As with core messages, CBOs should customize these messages to highlight their particular experience and success.

  • Our services can give your health plan a sales advantage—both in attracting and retaining members.
  • Churn in the marketplace may be expensive. We can help your organization with member retention.

1 Scripps Gerontology Center of Excellence, Strengthening Ties: Contracting Between Community-Based Organizations and Health Care Entities, https://www.aginganddisabilitybusinessinstitute.org/adbi-resource/strengthening-ties-contracting-between-community-based-organizations-and-health-care-entities/.

2 National Association of Area Agencies on Aging, Aging and Disability Business Institute, Lessons Learned from the Trailblazers Learning Collaborative: Steps to Getting Started on Health Care Contracting, https://www.aginganddisabilitybusinessinstitute.org/lessons-learned-from-the-trailblazers-learning-collaborative-steps-to-getting-started-on-health-care-contracting/.

What are Accountable Care Organizations and How Do They Work?

CMS defines Accountable Care Organizations (ACOs) asgroups of doctors, hospitals and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.”1 ACOs coordinate care to ensure that patients get the right care at the right time. ACOs are designed to reduce unnecessary duplication of services and medical errors while delivering high-quality care. When ACOs spend health care dollars more wisely, the ACO shares in the savings it achieves for the Medicare or Medicaid program.2 ACOs are available under Medicare, but several states have implemented ACOs in their Medicaid programs.

An ACO provides coordinated care to patients with the goal of limiting unnecessary spending. In this model, a primary care physician is responsible for arranging an individual’s care, with providers jointly accountable for the health of their patients, providing financial incentives to cooperate, ultimately saving money by eliminating unnecessary tests and procedures. For this to work properly, this group of providers must seamlessly share information about patient health. ACOs that save money while meeting specific quality targets get to keep part of the savings.

Providers and hospitals must meet specific quality benchmarks that focus on prevention and carefully managing patients with chronic diseases, earning more by keeping their patients healthy and out of the hospital. This focus on prevention and on chronic care management can provide important contracting opportunities for CBOs offering health promotion programs.

Learn more about which services CBOs are providing under contract with ACOs in this data brief from Scripps Gerontology Center that summarizes findings from the 2020 Aging and Disability Business Institute CBO–Health Care Contracting RFI Survey.3

 

Outreach Targets at Accountable Care Organizations

When preparing to connect with an ACO, determine whether your organization provides the services it needs. CMS makes public a great deal of data about ACOs that may help your organization better understand the goals and needs of a particular ACO. Performance data, with insights into overall quality scores, final sharing rate, minimum savings rate, minimum loss rate, benchmark and assigned beneficiary demographics are available in public use files.4

The next step is to determine how your CBO’s value proposition addresses any of the ACO’s needs or goals. By this point in the process, your CBO should have inventoried its existing relationships and identified connections that can facilitate discussions with a potential ACO partner. If no such relationships exist, making cold calls to personnel with the titles below within the ACO is another option, but it is always better to be introduced through a trusted partner.

See the Business Institute’s blog post, Lessons Learned from the Trailblazers Learning Collaborative: Steps to Getting Started on Health Care Contracting, for more information about beginning your outreach to a potential health care partner.5

The following are the titles/roles of the individuals at an ACO who are most likely to have say in arranging contracts for work.

  • ACO leadership (i.e., CEO, Service Line Executives, ACO Manager)
  • Head of Case Management/Utilization Management
  • Clinical Operations personnel

The following are the titles/roles of individuals who are likely to be brought in at later stages of contractual discussions. If your CBO has a connection to individuals on this list, they may be useful in opening doors to speak with the above-mentioned contacts.

  • Chief Transformation Officer
  • Growth/Strategy Directors
  • Chief Innovation Officer
  • Quality management (may be called Accountable Care Performance Manager)
  • Population Health
  • Clinical Integration manager
  • Regional Case Management lead
  • Chief Nursing Officer
  • Chief Medical Officer
  • Disease Management staff
  • Chief Financial Officer

Messaging to an ACO

Your strongest message will be one that connects the services your CBO provides with how your CBO will help the ACO achieve a goal, overcome a challenge or serve its patients. If your CBO has conducted research or worked with your target ACO before, you may already know what is needed. Crafting your messages so they focus on programs that will help the ACO meet those goals will be your strongest introduction. The objective is to do your best to identify where your services fit the ACO’s needs before initiating a discussion.

In general, an ACO’s goal is to ensure that patients get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.

In addition to the core messages your CBO has chosen to use, the following messages may be useful in subsequent conversations. As with core messages, CBOs should customize these messages to highlight their particular experience and success.

  • We are equipped to handle the entire scope of needs, including chronic conditions, substance abuse, dementia, mental illness and more.
  • We can serve as a single point of care coordination for an accountable care organization (ACO).
  • The HCCs that CBOs use can help ACOs get a higher rate of reimbursement for care.
  • We have the capacity to accept risk via performance-based contracts and incentives.

1 Centers for Medicare & Medicaid Services, Accountable Care Organizations, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO#:~:text=What%20is%20an%20ACO%3F,care%20to%20their%20Medicare%20patients.

2 Centers for Medicare & Medicaid Services, Accountable Care Organizations (ACOs), https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO

3 Scripps Gerontology Center of Excellence, Strengthening Ties: Contracting Between Community-Based Organizations and Health Care Entities, https://www.aginganddisabilitybusinessinstitute.org/adbi-resource/strengthening-ties-contracting-between-community-based-organizations-and-health-care-entities/.

4 Centers for Medicare & Medicaid Services, Program Data, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/program-data.

5 National Association of Area Agencies on Aging, Aging and Disability Business Institute, Lessons Learned from the Trailblazers Learning Collaborative: Steps to Getting Started on Health Care Contracting, https://www.aginganddisabilitybusinessinstitute.org/lessons-learned-from-the-trailblazers-learning-collaborative-steps-to-getting-started-on-health-care-contracting/.

What Are Health Systems and How Do They Work?

Health systems can be large or small and consist of a variety of components. Most often they are built around hospital services and medical practices but can also include skilled nursing facilities and home health. Additionally, health systems may include highly specialized services, such as mental health services, occupational health programs, billing companies, fitness centers and services akin to the work of CBOs, such as home-delivered meals, congregate meals, care transitions and housing programs. Some health systems are made up of smaller health systems working together across a larger geographical area or even the entire country.

Health systems can be structured as for-profit organizations, nonprofits or faith-based institutions. Understanding the organizational structure of the health system you are targeting will help you identify their priorities, goals and needs. 

Learn more about which services CBOs are providing under contract with health systems in this data brief from Scripps Gerontology Center that summarizes findings from the 2020 Aging and Disability Business Institute CBO–Health Care Contracting RFI Survey.1

 

Outreach Targets at Health Systems

When preparing to connect with a health system, determine whether your organization provides services it currently uses and needs.

The next step is to determine how your CBO’s value proposition addresses any needs or goals of the health system. By this point in the process, your organization should have inventoried your CBO’s existing relationships and identified connections that can facilitate discussions with a potential partner. If no such relationships exist, making cold calls to the health system outreach contacts listed below is another option, but it is always better to be introduced through a trusted partner.

See the Business Institute’s blog post, Lessons Learned from the Trailblazers Learning Collaborative: Steps to Getting Started on Health Care Contracting for more information about beginning your outreach to a potential health care partner.2

The following are the titles/roles of individuals at a health system who are most likely to have say in arranging contracts for work.

  • Health System Leadership (i.e., CEO, Service Line Executives)
  • Head of Case Management/Utilization Management
  • Clinical Operations personnel

The following are the titles/roles of individuals who are likely to be brought in at later stages of contractual discussions. If your organization has a connection to individuals on this list, they may be useful in opening doors to speak with the above-mentioned contacts.

  • Chief Transformation Officer
  • Growth/Strategy Directors
  • Chief Innovation Officer
  • Quality Management
  • Population Health
  • Clinical integration manager
  • Regional case management lead
  • Chief Nursing Officer
  • Chief Medical Officer
  • Disease Management staff
  • Chief Financial Officer

Messaging to a Health System

Depending on its size, a health system can offer multiple entry points for your organization. Understanding the variety of services offered, as well as any subsidiary organizations that are part of the system will help your organization identify potential areas for partnership. As you do with the health system, inventorying any contacts at each of those subsidiaries can help open doors. Your strongest messaging will connect the services your CBO provides with how your CBO will help the health system achieve its goals, overcome a challenge or serve its patients.

If you’ve conducted research or worked with your target health system before, you may already know what is needed. The objective is to do your best to identify where your services fit the system’s needs before initiating a discussion and then craft key messages to fit that understanding.

In addition to the core messages your CBO has chosen to use, the following messages may be useful in subsequent conversations. As with core messages, CBOs should customize these messages to highlight their particular experience and success.

  • We can support a variety of your service lines.
  • We can help health systems achieve a reduction in readmissions.
  • We can help lower the costs of services provided under a bundled payment arrangement—increasing your return.

1 Scripps Gerontology Center of Excellence, Strengthening Ties: Contracting Between Community-Based Organizations and Health Care Entities, https://www.aginganddisabilitybusinessinstitute.org/adbi-resource/strengthening-ties-contracting-between-community-based-organizations-and-health-care-entities/.

2 National Association of Area Agencies on Aging, Aging and Disability Business Institute, Lessons Learned from the Trailblazers Learning Collaborative: Steps to Getting Started on Health Care Contracting, https://www.aginganddisabilitybusinessinstitute.org/lessons-learned-from-the-trailblazers-learning-collaborative-steps-to-getting-started-on-health-care-contracting/

What Are Hospitals and How Do They Work?

A hospital is a health care organization that offers general and specialized medical, nursing and affiliated services and staff for the treatment of illness, injury and disease. Hospitals are often the first point of care for emergency situations or sudden illnesses. 

Hospitals are often for-profit, nonprofit or faith-based institutions. Specialty hospitals are also common. These include mental health hospitals, rehabilitation hospitals, cancer hospitals, orthopedic hospitals, children’s hospitals and geriatric hospitals. It is important to understand the organizational structure of your target partner to understand their mission, goals and challenges.

Learn more about which services CBOs are providing under contract with hospitals in this data brief from Scripps Gerontology Center that summarizes findings from the 2020 Aging and Disability Business Institute CBO–Health Care Contracting RFI Survey.1

 

Outreach Targets at Hospitals

When preparing to connect with a hospital, determine whether your CBO provides services it currently uses and needs.

The next step is to determine how your CBO’s value proposition addresses any needs or goals of the hospital. By this point in the process, your organization should have inventoried your CBO’s existing relationships and identified connections that can facilitate discussions with a potential partner. If no such relationships exist, making cold calls to the hospital outreach contacts listed below is another option, but it is always better to be introduced through a trusted partner.

See the Business Institute’s blog post, Lessons Learned from the Trailblazers Learning Collaborative: Steps to Getting Started on Health Care Contracting, for more information about beginning your outreach to a potential health care partner.2

The following are the titles/roles of individuals at a hospital who are most likely to have a say in arranging contracts for work.

  • Hospital leadership (i.e., CEO, Service Line Executives)
  • Head of Case Management/Utilization Management
  • Clinical Operations personnel

The following are the titles/roles of individuals who are likely to be brought in at later stages of contractual discussions. If your organization has a connection to individuals on this list, they may be useful in opening doors to speak with the above-mentioned contacts.

  • Chief Transformation Officer
  • Growth/Strategy Director
  • Chief Innovation Officer
  • Quality management
  • Population Health
  • Clinical Integration Manager
  • Chief Nursing Officer
  • Chief Medical Officer(s)
  • Disease Management staff
  • Chief Financial Officer

Messaging to a Hospital

Hospitals are often focused on population health issues, reducing readmission rates and controlling costs. If your target hospital is a nonprofit, that information can usually be found through local news stories, an annual report or asking an administrative staff member directly. Your strongest messaging will focus on connecting the services your CBO provides with how your CBO will help the hospital achieve its goals, overcome a challenge or better serve its patients. Equally important can be messaging describing your CBO’s community knowledge and involvement in community-based services. If you have conducted research or worked with your target hospital before, you may already know what is needed. The objective is to do your best to identify where your services fit the hospital’s needs before initiating a discussion.

In addition to the core messages your CBO has chosen to use, the following messages may be useful in subsequent conversations. As with core messages, CBOs should customize these messages to highlight their particular experience and success.

  • We can support a wide variety of your service lines.
  • We can help hospitals achieve a reduction in readmissions.
  • We can help lower the costs of services provided under a bundled payment arrangement—increasing your return.

1 Scripps Gerontology Center of Excellence, Strengthening Ties: Contracting Between Community-Based Organizations and Health Care Entities, https://www.aginganddisabilitybusinessinstitute.org/adbi-resource/strengthening-ties-contracting-between-community-based-organizations-and-health-care-entities/.

1 National Association of Area Agencies on Aging, Aging and Disability Business Institute, Lessons Learned from the Trailblazers Learning Collaborative: Steps to Getting Started on Health Care Contracting, https://www.aginganddisabilitybusinessinstitute.org/lessons-learned-from-the-trailblazers-learning-collaborative-steps-to-getting-started-on-health-care-contracting/.

What is a Medical Practice?

A medical practice is a business employing one or more physicians and associated staff for the treatment of patients.

Types of Medical Practices

The most common types of medical practices include private, group practices, specialty, independent practice associations (IPAs), hospital-based and insurance-based (like an HMO).

Learn more about which services CBOs are providing under contract with medical practices in this data brief from Scripps Gerontology Center that summarizes findings from the 2020 Aging and Disability Business Institute CBO–Health Care Contracting RFI Survey.1

 

Outreach to Medical Practices

When preparing to contact a medical practice, determine whether your organization provides services it currently uses and needs.

The next step is to determine how your CBO’s value proposition addresses any needs or goals of the medical practice. By this point in the process, your organization should have inventoried your CBO’s existing relationships and identified connections that can facilitate discussions with a potential partner. If no such relationships exist, making cold calls to the Primary Outreach Contacts at the practice is another option, but it is always better to be introduced through a trusted partner.

See the Business Institute’s blog post, Lessons Learned from the Trailblazers Learning Collaborative: Steps to Getting Started on Health Care Contracting, for more information about beginning your outreach to a potential health care partner.2

The following are the titles/roles of the individuals at a medical practice who are most likely to have a say in arranging contracts for work.

  • Medical Practice leadership (i.e., CEO, Practice Manager, CMO)

The following are the titles/roles of individuals who are likely to be brought in at later stages of contractual discussions. If your organization has a connection to individuals on this list, they may be useful in opening doors to speak with the above-mentioned contacts.

  • Quality Manager
  • Chief Nursing Officer
  • Disease Management staff
  • Chief Financial Officer

Messaging to Medical Practices

Medical practices typically have limited resources to draw on when it comes to reimbursement for services—though they are likely to be the most closely focused on patient needs. Large medical groups (like insurance-based or a large HMO practice) may be the best targets for outreach, though practices in general are usually very open to discussing challenges they face due to reimbursement. You may want to tailor your messaging to communicate how efficient and highly effective your CBO’s services are. These messages are likely to be well-received. If you have worked with your target medical practice before, you may already know what is needed.


1 Scripps Gerontology Center of Excellence, Strengthening Ties: Contracting Between Community-Based Organizations and Health Care Entities, https://www.aginganddisabilitybusinessinstitute.org/adbi-resource/strengthening-ties-contracting-between-community-based-organizations-and-health-care-entities/.

2 National Association of Area Agencies on Aging, Aging and Disability Business Institute, Lessons Learned from the Trailblazers Learning Collaborative: Steps to Getting Started on Health Care Contracting, https://www.aginganddisabilitybusinessinstitute.org/lessons-learned-from-the-trailblazers-learning-collaborative-steps-to-getting-started-on-health-care-contracting/