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HomeHealthcareBuild mutually beneficial partnerships between payers and community organizations

Build mutually beneficial partnerships between payers and community organizations


As we rebuild our communities from the Covid-19 crisis, we must work together to close the growing health equity gap.

The path to sustainability and improved health outcomes requires collaborative efforts. In order to meet the most urgent needs of the worst-hit communities, we must support community organizations (CBOs) that actively respond to the social drivers of health and establish more effective interventions that promise to provide long-term solutions.

Four challenges faced by CBOs and payers

Payers, suppliers, and CBOs have a long history of comparison targets. There is no doubt that the sustainable way to build a more integrated healthcare ecosystem is through partnerships. But for these collaborations to be successful, communication and clear financial incentives need to be aligned.

It is often challenging for payers and CBOs to find this consistency and establish mutually beneficial partnerships. We found that there are two main reasons for the failure of these partnerships in the past. The first is trust and consistency. All stakeholders—CBOs, payers, and healthcare organizations—must have a place at the decision-making table to ensure trust and consistency. The second reason is limited funds. The payer has more funds than the CBO, which creates an asymmetric power dynamic. To support CBOs, payers should consider payment models that enable CBOs to increase capabilities, resources, and capabilities.

This American Journal of Public Health Recently addressed the challenge of establishing inter-departmental relationships, suggesting: “The successful integration of health and social services may depend on several components, including the degree to which the integration occurs, the participation of partners, whether the partners have common goals and roughly equal contributions. Willingness and ability, and the degree of integration.”

Work towards the same goal

Moving away from the pay-for-service model, payers and CBOs can implement quality programs that focus on the Social Determinants of Health (SDoH) to reimagine the impact of preventive health care and quantify services based on their direct impact on population health.

Assume that there are 100,000 members in the community “at risk of food insecurity”. The payer can make a conscious decision to allocate US$5 million (US$50 per person per week) to CBOs that carry out food projects in the area. To measure the success of the decision, the payer can evaluate closed-loop referrals, emergency room visits, hospitalizations, chronic disease care costs, and additional health-related costs.

Value-based systems like this are designed to provide patients with high-value care to improve their overall health and reduce long-term medical costs. Value is measured by evaluating the health outcomes associated with the cost of achieving the improvement.

Suppose we successfully use this system to solve SDoH. In this case, the payer and the CBO will have the same goal of improving the health of the population, and can work together to integrate their systems, share data, measure patient outcomes, and participate in a reimbursement model that provides more specific incentives to the CBO.

More risk equals more reward

In the value-driven risk-sharing model, CBOs are encouraged to become more active participants. When both parties agree to take financial risks (based on forecast data, of course), they should share the profits. It’s that simple. Providing financial support to CBOs will not only improve the partnership between payers and CBOs, but will also actively change the health of high-risk groups, many of whom live in low-income and rural communities.

As the social service network develops and its value increases, CBOs may have to expand their scope of services, transform their organizational structure, and improve their coordination services, but they at least have the funds to do so-and the payer will know Their money is being used for the highest quality care.

Without community organizations working locally to meet the health needs of high-risk groups, it will be impossible to achieve health equity. If executed successfully, the relationship between the payer and the CBO may prove to be the most beneficial in the healthcare ecosystem.

Photo: alphaspirit, Getty Images



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