Challenges to Building Mutually Beneficial CBO-Payer Partnerships



Payers and other organizations from across the healthcare spectrum are increasingly looking for opportunities to meaningfully partner with community-based organizations (CBOs) to address the social determinants of health (SDoH), which impact as much as 60 percent of a person's overall health. Supporting these partnerships is particularly urgent right now, in light of the host of negative downstream effects — increasing food insecurity, housing instability, and more — that are being documented in connection with the ongoing disruption driven by COVID-19.

It's urgent for a more prosaic reason, as well. With the bipartisan Improving Social Determinants of Health Act of 2021 on the horizon, it's time for all of us to start thinking critically about the current state of CBO/payer partnerships. What's working well? What isn't? What can we do to fix the latter?

However, for payers to get the right outcomes, it's going to be crucial that the valuable perspectives and experiences of CBOs aren't lost in the conversation. With that in mind, here are three insights we can bring to the table.

1. Barriers From the Bottom Line Up

Perhaps the most widespread challenges that CBOs face in considering partnerships is truly an existential one. Reliant on grants for the majority of funding, stretched thin by resource constraints, and in many cases already over capacity, the workload that comes with these partnerships can put a severe strain on CBOs' operations. In fact, even just ramping up in preparation for partnership can stress a CBO's capacity and capital to the breaking point.

This is something payers can step in to rectify. When Meals on Wheels America wanted to scale its service delivery to homebound seniors, for example, the Medicare Advantage Plan they partnered with went the extra mile by financing many of the initial capital costs. If more payers were to follow in their footsteps, and perhaps even to factor some of those financial outlays into the costs of developing partnerships, there's no telling the potential impact that could result.

So the real bottom line, at least where health outcomes are concerned, is that access to more funding—and funding from more diverse sources, including payers—will be an absolutely essential ingredient in effectively addressing SDoH at scale.

2. Resource Constraints

For most CBOs, operational resource challenges and constraints are clearly linked to broader issues of funding, as discussed above. However, these challenges should be broken out separately, as they present a different series of opportunities for payers to intervene in the interest of fostering effective partnerships. Because of the collaborative work these interventions require, they're a means of not only providing much-needed material support to CBOs but also setting the stage for a more successful partnership down the road.

Data, for example, is often a key deliverable for CBOs exploring partnership opportunities, yet it's not always something these groups have at the ready. Likewise, few CBOs have data analysts on hand to process the data and prepare it for reporting.

For payers interested in high-impact partnerships, that's a clear opportunity. For example, why not offer consultative support to help the CBO prepare data-oriented deliverables ahead of time? This kind of support would be particularly valuable during the exploratory phase of the relationship. Plus, it could help ensure CBOs are able to meet core requirements around data deliverables down the line, to boot.

It's a good example of the kind of practical measures that payers can take that often go a long way toward cementing trust and ensuring alignment—a topic will turn to next.

3. Core Issues Around Trust and Alignment

Unfortunately, building trust while ensuring alignment is one of the thornier issues for CBOs when it comes to considering potential partnerships. It's a topic we've written about extensively in the past, largely because trust and alignment have the power to derail even the most promising of CBO/payer partnerships.

Fortunately, though, we aren't operating in a vacuum here: There's a substantial, rapidly growing body of literature to draw on for answers that can help with trust and alignment. What characteristics have been shown to facilitate trusts in CBO-payer partnerships, based on real-world experiences? Three key findings from researchers:

  • Shared Mission: The goal of the partnership should be to amplify health impact for both parties. This is a non-zero-sum situation. Act accordingly.
  • Alignment: Payers and CBOs may be coming to the conversation from vastly different worlds, with different norms, protocols and cultures. Payers have to demonstrate that they recognize that fact.

Communication: Defining the right communication channels and establishing a meeting cadence early on in the relationship is key to ensure all stakeholders are in the loop. Take the time to listen and learn so you can uncover areas of contention.

Check out this article from the Journal of the American Medical Association for more insights around trust-building in CBO-payer partnerships.

Looking Ahead: What's Next for CBO-Payer Partnerships?

Achieving a greater degree of cohesion, integration, and partnership between CBOs, payers and other players in the healthcare ecosystem is clearly a necessary step for us to move the needle on SDoH, increase health equity and realize better health outcomes for all. In the interim, there remain roadblocks that will need to be overcome, and payers would do well to begin actioning some of the guidance we've outlined above.

For a deeper look at the state of CBO-payer partnerships and more insights into the experiences and pain points of CBOs entering into them, download our comprehensive white paper: CBOs and Payers: Challenges to Building Mutually Beneficial Partnerships.

DOWNLOAD the white paper ›

Topics: public health healthcare policy population health community-based organizations white paper sdoh

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