The Role of Strategic Thinking in Preparing for Health Care Contracting

Aging and disability community-based organizations (CBOs) can find tremendous opportunities to address the social determinants of health (SDOH) through the integration of social services and health care.[1] Often, these opportunities arise in a manner that requires CBOs to react quickly, which can create an urgency that leaves little time for strategic thinking—and can lead to poorly defined contracts, challenges around competing priorities and a loss of focus on organizational mission and vision. 

There is a better way to plan for success. Some CBOs are using a strategic planning process as a springboard for health care contracting. This process involves clearly defining your CBO’s direction and setting goals, objectives and specific tactics that will move your CBO forward. This stage of planning allows CBOs to lay out actionable steps that will come in handy when approaching a potential health care partner. 

Below are a few elements that should be considered by CBOs as they undertake strategic planning, including lessons learned from CBOs that have found ways to maintain a strategic direction and rapidly respond to the needs of health care partners.

Understand who you are, what you can provide and what you do best. The Mid-America Regional Council (MARC) of Kansas City, Missouri began thinking about health care contracting as a way to grow and sustain the delivery of their evidence-based programs (e.g., Chronic Disease Self-Management Programs). Funding from the U.S. Administration for Community Living (ACL) to the Missouri Association of Area Agencies on Aging (MA4) allowed MARC leadership to engage in strategic thinking about possible health care contracting.

MARC explored its organizational strengths, the populations that would benefit from those strengths and how those strengths could best solve the needs and pain points of potential health care partners. Through this process, MARC identified existing services that would be attractive to health care partners because of their impact on costs, including home-delivered meals, medication reconciliation through HomeMeds and care management. MARC and its fellow Area Agencies on Aging (AAAs) in Missouri found that, by formally collaborating, they could meet the needs of payors and consumers in their state even better. In order to do this successfully, they would need to structure that collaboration into a network. As a result, MARC and the other Missouri AAAs formed a Managed Services Network with the capacity to provide statewide access not only to evidence-based programs but also to nutrition services, community care management and transportation.

Engage key stakeholders early on. When Elder Services of the Merrimack Valley (ESMV) began thinking about how to sustain its evidence-based programs, it engaged a variety of stakeholders who would be invested in their health and wellness mission. Among them were the Massachusetts Executive Office of Elder Affairs (the State Unit on Aging), the Massachusetts Department of Public Health, community partners, older adults and potential payors, like managed care and health care providers. These stakeholders leveraged the perspective of their various sectors and influenced the development of The Healthy Living Center of Excellence, which serves the needs of health care systems by managing a network of CBOs.

Understand the external environment. While the benefits of social service and health care integration are ubiquitous, the specific programs, services outcomes and payment structures supporting integration can vary by state or region. Once your CBO identifies key stakeholders that should be involved in your strategic planning process, it should perform an environmental scan to help identify and monitor factors both inside and outside your organization that will impact the long-term viability of your work. This environmental scan allows CBOs to explore how their mission, culture, employee and leadership engagement, resources and internal capacity will impact its ultimate success.

The process also involves looking at those internal factors that will contribute to your CBO’s success, including your position with respect to competitors and collaborators in the market, as well as other political, economic, legal or other environmental factors that will impact success. The Aging and Disability Business Institute’s Readiness Assessment Tool can help a CBO determine its readiness to begin contracting with health care entities by evaluating a set of internal and external factors.

In its 2017 strategic planning process, environmental scanning allowed ESMV to predict the policy shifts that incentivized the state’s Medicaid Accountable Care Organizations to partner with social service organizations to address nutrition and housing challenges. As a result, ESMV was able to build capacity for medically tailored meals, medical nutrition therapy, healthy food resources delivery and housing preservation. Because of ESMV’s forward-thinking and strategic planning, it was able to lay the groundwork for two contracts with ACOs to deliver these supplemental services.

Think about what your CBO wants to achieve and who is accountable. For many CBOs, the goal of social service and health care integration is improving outcomes for older adults. In this case, strategic planning needs to consider how CBOs will measure those improvements, who will be accountable for achieving them, what technology will be necessary and what other investments will be needed to support the work. What will be the measures of success in your health care contracting? Increased activation or engagement of patients? Reduced unnecessary health care utilization? Improved health outcomes? Does your CBO have access to data that you can use to measure these outcomes? Many promising contracts have failed because the measures of success focused on elements (e.g., health outcomes) which the CBO did not have access to. Others have failed due to misalignment in accountability, particularly when many CBOs come together as a network. To create clarity around accountability, many networks decide to formalize their structure—clearly establishing roles and expectations for all parties involved.

When thinking strategically about how contracting with health care would be successful, three AAAs in Maine decided to create a community-based network, Healthy Living For ME. Using a Joint Operating Agreement as the tool to define the roles and accountability of its members, Healthy Living For ME clearly defined how the network would operate and how necessary investment in building the network would be shared among the three AAAs involved.

Finding the time and resources to think strategically amid the pressure to secure a health care contract can be challenging. CBOs that effectively balance these competing demands have the greatest opportunities in long-term success, both in terms of advancing the health and wellness of the consumers they serve and in sustaining their work. Not sure where to start? Take a look at the Aging and Disability Business Institute’s Readiness Assessment tools.


[1] The following publications provide insight into these opportunities: Building a Foundation for Health Care and Community Based Organizations Partnership, Building Partnership with Primary Care to Become a Hub for Service Delivery for Older Adults in Our Community, Health Care and Community Based Organizations have Finally Begun Partnering to Integrate Health and Long Term Care