CBO Guide to Jump Starting Value-Based Care

Value-Based Care Consulting

Brent T. Feorene, COO

It’s about time.

Healthcare is finally catching on to what community-based organizations have known for years: the social conditions of someone’s life are just as important as the medical aspects when it comes to health (sometimes even more!). Conversations about the social determinants of health dominate headlines, industry conferences, board room discussions, and strategic plans. No longer an afterthought, community-based organizations (CBOs) are gaining recognition as catalysts for “smart health.”

Healthcare organizations – providers and plans – are starting to pursue relationships with community resources to better serve their local populations. It’s part of a larger strategy to fortify their comprehensive care management programs by addressing the nonmedical needs of patients in a manner that will improve health outcomes. For risk-bearing organizations, that also equates to better financial margins. But being acknowledged as a valuable resource doesn’t guarantee that a CBO will able to plug into the care continuum easily. In fact, many are struggling to figure out where they fit and how to go about engaging. Nearly 40% of CBOs responding to a survey by the Scripps Gerontology Center reported they need more information and guidance about how to establish these partnerships.

Three steps to getting started

Most CBOs will need to transform their capabilities to better align with healthcare organizations engaged in value-based care. It’s in these arrangements that providers and plans see the most immediate need for community resources.

If you’re a CBO, follow these three steps to mobilize for your future success.

1. Understand and align your value in terms of the health system at large.

Knowing where you bring value is critical to understanding your fit with healthcare partners. Care teams aim to deliver highly-personalized health services across the continuum—all while being good stewards of resources. For CBOs to integrate with the health system at large, they must fully understand the specific goals care teams are looking to achieve.

For example, if an acute care hospital’s goal is to reduce readmissions, the CBO must understand who is most at-risk and which interventions it can deliver to realize the greatest impact. Perhaps it’s transportation to outpatient primary care appointments, or delivery of nutritious meals.

Over time, outcomes data will provide evidence of the highest-value interventions, providing a roadmap for the CBO to follow. The regular examination of outcomes will close the loop between the care teams and the CBO.

Such alignment requires a like-minded culture, collaborative efforts, and sharing of information. CBOs must ensure they have a venue for communication with care teams and a method of continuous quality improvement that reflects the larger health system’s value proposition.

2. Reposition the culture.

Community organizations have a historical legacy of assisting the most vulnerable populations with food, transportation, housing, security, and activities of daily living. While that core mission remains unchanged, the mindset around it must evolve in the value-based environment.

Earning a profit while delivering services is not inconsistent with the mission of caring for people. The motto of “no margin, no mission” is especially relevant for those who have re-engineered their roles, moving to a culture focused on community impact and sustainability.

Leaders must examine solvency not just in the short-term but with a view toward a sustainable future, which will include significant opportunities for growth. With increasing scale, CBOs can extend their mission with greater stability, which will become an asset as healthcare partners demand more sophistication from CBOs.

Rather than fearing the shift toward bottom-line business operations, CBOs should embrace it.

3. Optimize people and processes.

The payers and providers partnering with CBOs are essentially customers who want turnkey services that help them achieve better outcomes with lower costs. That means CBOs must take a hard look at how their people and processes meet those emerging customer needs.

For example, organizations might need to recruit workers experienced in care coordination, then operationalize the workflows needed to make those staff members effective in the community. Other new investments might include technology tools, such as secure messaging apps to engage patients, or data analytics to report quantitative results back to the payer or provider customer.

As difficult as it might be from a management perspective, leaders must also re-evaluate the capabilities of their existing teams to determine whether their complement of skills fits with the CBO’s changing vision for the future.

The people and processes that allowed CBOs to be successful in their roles in the past are quite different from what is needed to flourish in today’s landscape of value-based healthcare.

The wrap-up

Having finally achieved the recognition they so deserve, community-based organizations now face the challenge of integrating into the broader healthcare continuum. Doing so effectively demands leadership with a vision for the future and the ability to rally the organization around that vision. It also requires a review of existing capabilities, processes, and tools against the backdrop of the future, as well as the fortitude to implement change where needed. Successful examples are beginning to emerge and can provide additional information for CBOs just beginning to pursue healthcare partnerships. Look to trusted peers for insights and consider engaging third party expertise to help your organization navigate around obstacles and achieve your vision and mission even faster.