Community based organizations are the next frontier in healthcare. CBOs provide essential social services including transportation, food, and housing, among other benefits. It is well known that social determinants of health (SDoH) play a huge role in health outcomes, far more significant than the direct care we receive from doctors and hospitals. And now health systems, particularly accountable care organizations (ACOs) are starting to view CBOs as partners in healthcare delivery.
The problem is that CBOs are often underfunded, understaffed, and not integrated with nearby health systems. Imagine thousands of not-for-profit “mom and pop” style organizations that have little or no experience collecting data or establishing workflows with healthcare partners – CBOs are like the wild west!
Building CBO infrastructure. While CBOs have great potential to improve healthcare delivery, these organizations are not ready. So now health systems are beginning to consider how to build up CBOs in terms of service capacity, data management and reporting. A good place to begin searching for valuable lessons in this area is the Data Across Sectors for Health (DASH) program, sponsored by the Robert Wood Johnson Foundation. This program enacted various data sharing partnerships and highlighted the key challenges health systems might face when attempting to build partnerships with different types of organizations, like CBOs. At first glance, building a successful data sharing partnership with an underfunded CBO may take a long time. This is why I’m not totally sold on the idea of building CBO capacity through “soft” engagement activities without direct and substantial funding.
We need more CBO heavyweights. CBOs with established operational capacity, and a track record for delivering a comprehensive suite of services, should expand their operations through takeovers of smaller, inefficient CBOs. And health systems should prioritize these CBOs by referring the majority (if not all) of their patients to select CBOs. This might occur naturally under accountable care delivery – ACOs will prefer partnerships with efficient CBOs, and these CBOs will receive more funding (probably through shared risk contracts), re-invest in their operations, and gradually expand.
But are there specific strategies that can accelerate the growth of “Amazon-like” CBOs? My hope is that commercial entities (tech companies or private equity firms) will invest in building high-value healthcare networks with CBOs at the center. They only need to see the value in buying up CBOs in certain areas to reorganize them into a single effective partner for large health systems. The payout from such investments would probably come from future savings in healthcare spending, through special risk-sharing contracts with commercial payers, Medicare and Medicaid.
First things first – the population health community must repeatedly demonstrate reduced healthcare spending among patients who receive social service support. Otherwise, it’s just a waste of time and money. Things should become clear in another 5 years.
~ James
