Connecting the dots in healthcare
Bruce Chernof, M.D., SCAN Foundation
Innovation in healthcare is not a new concept, and few industry leaders can think of a sector that has not been touched by transformation of one kind or another. Some transformations are larger and more visible than others, yet its collective impact will continue to reshape how and who provides care for decades to come.
A less visible player in this early transformation is the small set of community-based organizations seeking to deliver coordinated care to people coping with multiple chronic conditions and functional limitations who wish to live well and safely in the community. The guiding premise is that the Affordable Care Act created many of the new care delivery opportunities to improve quality and cost effectiveness of healthcare – and these goals are best achieved when people with high needs and high health care costs can easily crosswalk between medical care and long-term services and supports provided in the community.
In order for this to work, CBOs need to have effective relationships with the health care sector, and this usually means having formalized contractual partnerships that have been well negotiated on both sides of the equation.
The sticking point of all this progress is that most garden variety CBOs lack the required business acumen and need to develop a variety of internal organizational capabilities before they can enter into mutually beneficial contractual partnerships with the sector.
In 2013, The SCAN Foundation sought to overcome this knowledge and transformation gap by developing Linkage Lab, a program that provided capacity-building skills and organizational transformation support through regular seminars and on-the-ground technical expertise. Six California CBOs participated and by early 2015, this first cohort signed 27 contracts with health care providers with potential to serve over 16,000 individuals annually.
Below are a sampling of successes and challenges for each organization:
Bay Area Community Services: BACS shifted from their original mission as a nutrition provider to an array of services that included piloting a medical respite program with Alameda Alliance Health Plan targeting homeless adults being discharged from the hospital. In Phase 1 of the pilot, 98% of medical respite participants were not re-hospitalized for their condition, and 30% were transitioned from the medical respite program to permanent housing.
Camarillo Health Care District: A government agency, the District leveraged their experience as a Community-Based Care Transitions site to realign and appropriately price a package of care management services. This led to establishing a contract with a national managed care organization to focus on high-risk individuals in their community.
Institute on Aging: IOA renovated its data collection infrastructure, which helped them establish their value proposition to outside partners. IOA partnered with Brilliant Corners, a non-profit housing provider, and together they won a contract to provide supported housing with intensive care management for high-risk members of the Health Plan of San Mateo, one of California's Medicare-Medicaid demonstration plans.
Jewish Family Service: JFS analyzed and renovated core business operations to inform contractual negotiations with health systems, including staffing patterns, accountability, performance, care delivery improvements, and data collection. This change prepared them to negotiate successful contracts with health plans in the Medicare-Medicaid demonstration, hospitals, and community health centers.
Silicon Valley Independent Living Center: Recognizing its niche serving high-needs adults with disabilities seeking to live in the community, SVILC packaged its transition and care coordination services together successfully in order to negotiate contracts with the two health plans participating in Santa Clara County's Medicare-Medicaid demonstration.
St. Paul's Senior Services: St. Paul's is a multidimensional retirement community that hosts a PACE (Program for All-inclusive Care for the Elderly) site. By leveraging its existing competencies care coordination competencies and exploring home- and community-based services that could be packaged for health care payers and providers, St. Paul's negotiated a successful contract with one of the health plans in San Diego's Medicare-Medicaid demonstration.
In addition to these case studies, the Foundation released additional resources to prepare community-based organizations ready for this challenge to both see the road ahead and take active steps along this transformational path.
A free online learning series based on core content from the Linkage Lab program (developed in collaboration with Health Foundation of Western and Central New York)
Pricing and sustainability toolkit to help CBOs identify and communicate the value of their services
Additional papers describing why CBOs are the right partners for health plans and strategies to train care coordinators for integrated care models.
It is time for all providers serving Americans with daily functional needs to break out of their individual silos and proactively connect to create an integrated platform of care. The experience of the first six Linkage Lab grantees shows that healthcare sector-CBO partnerships are possible and fruitful for both consumers and providers. Bringing together the best capacities of the health and long-term care sectors can deliver on the promise of true person-centered care: right care, by the right provider, at the right time, for the right price.