Healthcare organizations are exploring ways to fund partnerships with community-based organizations
Medicare and Medicare Advantage are in the midst of a seismic shift toward value-based care. As a result, they are focusing on the social determinants of health (SDOHs) in a variety of ways, including adding flexible benefits for seniors and launching innovative partnerships with community-based organizations (CBOs).
With up to 60 percent of clinical outcomes directly tied to the circumstances in which individuals live, work, and play, CBOs provide vital services to support improved long-term outcomes and a higher quality of life for many communities. CBOs tend to rely on grants and private philanthropy to fund their programming. But as the clinical care system starts to refer more and more individuals to CBOs for non-clinical services, CBOs are increasingly in need of additional revenue streams to manage the increasing demand for services.
“There has been a surging interest in cross-sector partnerships, specifically between healthcare and CBOs,” said Manik Bhat, Chief Executive Officer and founder of Healthify. “Now that the industry is focused and interested in formal partnerships with social service organizations, how are we scaling those partnerships in an equitable and financially viable manner?”
Medicare and Medicare Advantage are taking the lead by implementing a series of new policies, benefits, and reimbursement options to support community-based work. As part of Medicare Advantage, for example, CMS has finalized new supplemental benefit provisions that encourage health plans to target access to healthy foods, transportation to medical appointments, and health and wellness education.
There are more than 22 million Medicare Advantage beneficiaries across the nation, leading health plans to offer high-impact benefits, including adult daycare, home safety improvements, personal home helpers, and care navigators. Traditional Medicare beneficiaries with providers participating in accountable care organizations (ACOs) are also seeing an increased emphasis on their socioeconomic needs.
A recent survey by the Institute for Accountable Care found that three-quarters of ACOs work closely with CBOs to address food insecurity, housing instability, transportation needs, and social isolation concerns that can contribute to higher spending and lower quality.
“Health plans play a major role in pushing health systems to incorporate social services into value-based contracting by aligning incentives or mandates appropriately,” said Bhat. “When health plans incorporate social services into accountable care arrangements, they promote adoption of CBO partnerships and programs that can change the course of an individual’s life.”
To learn more about how healthcare organizations are working with CBOs to fund and scale their programs, download our latest resource, “Funding Community-Based Efforts to Address the Social Determinants of Health.”