Like politics, it’s been said that all healthcare is local. But when it comes to the role of community-based organizations (CBO) in supporting health, payers and other stakeholders haven’t quite known how to include their closest neighbors. Add to this the rising importance of social determinants of health (SDOH), which CBOs may be qualified to identify and meet but also disadvantaged to address from a healthcare system perspective, including value-based arrangements.
The challenges CBOs, health plans, and state Medicaid programs face in working together range from data and technology to contracting and payment capabilities. “Many CBOs lack sustainability,” says Lynn Carroll, COO and head of strategy for HSBlox.”It is up to payers—or the holders of the financial and outcomes risk for the individual—to create the infrastructure and processes to add CBOs to their VBC models and pay them for their services.”
And yet it is these very organizations that can often make the most immediate and personal contact with someone in need. “The organization providing care in the home or community is going to be the first one to see when a change in a person’s health status has occurred,” adds Carroll. There are a growing number of health plans, Medicaid- and Medicare-focused programs, and tech solutions that are emerging to include CBOs and maximize their role in whole-person health.