How Can APM Participants Better Engage Community-Based Organizations?

As they gain experience with alternative payment models, how can healthcare executives do a better job of partnering with community-based organizations (CBOs) to address patients’ health-related social needs and decide what is meaningful to measure? A panel of innovators at the Health Care Payer Learning & Action Network (LAN) Summit in Washington, D.C., described their experiences.

The panel was moderated by Marshall Chin, M.D., M.P.H., professor of healthcare ethics at the University of Chicago and the LAN’s Health Equity Advisory Team (HEAT) Co-Chair, and Karen Dale, R.N., M.S.N., market president of AmeriHealth Caritas District of Columbia and HEAT Co-Chair.

“The HEAT has developed a theory of change focused on how alternative payment models advance health equity. An important driver of change, among others, is partnering with community-based organizations providing local health-related social needs services,” Dale said. “The HEAT has been hard at work over the past year to develop guidance, which facilitates action to establish impactful partnerships with CBOs that are trusted and responsive to health-related social needs in a community. By way of these important partnerships, the communities will more likely experience positive health outcomes and full engagement concurrently. Healthcare partners can reduce traditional medical care expenditures by addressing these needs and potentially preventing downstream resulting health issues, conditions or other healthcare challenges.”

Chin and Dale asked panelists for examples of how they work on equity projects with CBOs and how they measure progress.

Deepak Sadagopan, chief operating officer of population health at Providence, spoke about an effort to address maternal health disparities in the Pacific Northwest. He leads population health initiatives across Providence, including value-based care growth, a $50 million investment in health equity, and Medicare/Medicaid management for quality care at more affordable prices. In addition, he serves as the CEO of Health Connect Partners LLC, the Providence ACO serving more than 110,000 assigned members as part of CMS’ MSSP program.

A few years back, Providence initiated the Just Birth network, which was targeted towards increasing the percentage of African American and Native American communities who were receiving pregnancy and postpartum care doula services. “The whole initiative was focused on funding doulas, as well as enabling the emergence of independent doula agencies in the communities to work with these populations. “Our goal was to see reduced C-section rates in these populations compared to the rest of the population that we were seeing in our in our hospitals,” Sadagopan said.

“Just in one hospital in western Washington, we served about 202 patients 111 of those were connected to care in some type of cultural navigation, and the results were that 97 percent of the patients recommend giving birth at this hospital because of the experience with the navigator, and 95 percent felt that the care navigators were able to meet their needs as opposed to persistently seeking access to doctors or others, so that we were able to broaden access significantly,” Sadagopan said.

“The C-section rates had a noticeable difference between 2019, when the program was initiated, and now in 2023. It has taken about four years for us to see these results, but the gap in C-section rates has almost closed,” he said. “Avoiding a C-section is great for from a total cost of care and a value-based care standpoint because you're avoiding hospitalization, and it improves your total cost of care. But more importantly, it improves the quality of life for that mother. It is an example of the persistence it takes and the road that needs to be followed in these areas.”

Kelly Cronin serves as deputy administrator and director of the Center for Innovation and Partnership at HHS’s Administration for Community Living. She was asked what it would look like to align the different community and health stakeholders around medical and social needs.

“We've seen a lot of success with CBO networks forming that can really represent the interests of the full community,” she responded. “It's not necessarily an interest of just one organization that deals with the housing issue or one community health center or health system, but really taking a multi-stakeholder approach and thinking: how do we build the community-wide capacity across a whole network of CBOs to be able to be community-focused in an approach to addressing health-related social needs?”

Cronin said it is important to form mature networks that will be able to deliver a comprehensive set of services to address health and health-related social needs. “We're excited about this growth. HHS is also trying to support community care hubs as backbone organizations that can contract with Medicare Advantage plans, ACOs and Medicaid managed care plans. An FQHC can be that multi-payer source and point of entry to the community to be able to manage across the network of CBOs.”

Bukata Hayes, vice president and chief equity officer of Blue Cross and Blue Shield of Minnesota and board chair of the Blue Cross and Blue Shield of Minnesota Foundation, talked about improving engagement with community-based organizations.

“We as healthcare have measured success in some important ways, yet not totally aligned with community. I know that as a health plan, we put out solutions and oftentimes have low engagement,” Hayes said. “There's no way we will improve outcomes if we don't get engagement. Part of it is how we are actually incentivizing engagement. Measuring engagement is the most critical first step to actually getting better outcomes.”

Hayes added that if you can align the objectives of the health plan with the mission of the community-based organization and engage them to develop a strategy that advances the health of a population from an equity standpoint, then you will get engagement.

Timothy P. McNeill is the founder of Freedmen’s Health, a Washington, D.C.-based healthcare consulting firm specializing in implementation of innovative models of care. He said there need to be clear expectations outlined upfront as to the expectations of any intervention.

“If you are doing an intervention to address food insecurity, but it's not clearly outlined that we want to move the needle on A1c or on hospitalization, but then you come back and say well, you didn't improve what we want to see with this population, there's a disconnect,” McNeill said. “So there needs to be this engagement upfront, and co-planning and co-designing of what the innovation is, and that's where you get the most impact from your partnership with community-based organizations.

Hayes added that another key to success is humility. “I think far too often we enter this space with the community believing we have the answers. And I would say that if we had the answers, we would have implemented those as healthcare a long time ago and been really successful. As we think about health equity, we have not been as successful as we would have liked. Community-based organizations have done some things that we have not been able to do as far as engagement, trust building and a few other things. We have to be willing to cede some of our power in these spaces. We have to do the things that build trust.”