Managed care organizations (MCOs) and community-based organizations (CBOs) have increased collaborative partnerships in recent years as a strategy to deliver services through value-based care (VBC) contracts.
However, bringing together 2 very different entities—large health plans and small non-profits—requires a respectful and honest approach if both want to achieve their separate and shared care objectives.
Addressing social needs and equity through value-based care
Health care organizations (HCOs) and, specifically, MCOs, commonly opt out of building social need programs. Instead, they may partner with CBOs. This strategy makes sense where healthcare and social needs intersect due to the intimate and deep connections CBOs develop within the community through support services, home visits, and personal engagement with community representatives.
Partnering with a CBO that has established an existing infrastructure and a track record of success is a cost-effective strategy for MCOs to build and deliver a full complement of health and social services.
Today, there are more than 200 MCO-CBO partnerships and 20,000 national CBOs, creating a network through federal and state investments.
The pandemic exacerbated social needs and highlighted the value of CBOs
Many Medicaid MCOs regularly screen new beneficiaries and connect them with CBOs. This practice revealed a substantial increase in new enrollees' unmet needs due to the COVID-19 public health emergency.
While this increase in demand was an incredible strain for CBOs to respond to, it pushed them to innovate in several ways, including:
- Creating new ways to respond to higher demand
- Searching out new funding sources
- Creating flexible communication modes
- Increasing and evolving partner relationships
The pandemic demonstrated the value of MCO-CBO partnerships to more effectively:
- Link beneficiaries to clinical and non-clinical services
- Engage members more deeply in their health and care
- Enable providers to focus more on clinical issues knowing that social supports are in place
Ultimately, MCOs need the community connection that CBOs deliver to build awareness and goodwill while providing direct services they can't or choose not to develop or scale organically.
Partnerships with CBOs can prioritize member social needs that are inhibiting the payer's ability to address underlying health needs. For example, a patient is not as concerned with how they are going to pay for their blood pressure medications if they are focused primarily on securing stable housing for their family. Person-centric programs can address the individual's hierarchy of needs.
MCO-CBO partnerships rely on common aims and complementary capabilities
MCOs and CBOs have similar objectives that bring them together:
- To improve social determinants of health
- Reduce health disparities
- Prevent illness through enhanced access, delivery, and care management
An MCO may have several CBO partnerships to deliver various interventions and address several social needs. The health plan uses data to identify gaps in care and provides referrals to, or integrated services with, CBOs via partnerships.
In addition to shared ideals and possibly overlapping objectives, MCOs and CBOs each offer unique capabilities, competencies, and skillsets. That's the heart of the partnership.
The focus of collaboration should be on creating a transformational relationship, not a transactional one.
Through start-up grants, a reliable influx of people to serve, and in-kind support and resources, a CBO can fulfill its mission to support its community. For MCOs, the partnership helps them address member and community needs, attract and retain members, lower long-term costs, and improve outcomes performance. It also positions the MCO to benefit as Medicaid coverage expands in some states.
The partnership can be mutually beneficial as Medicaid covers many of the services that MCOs and CBOs are partnering to provide, including clinical and behavioral health services, transitions of care management and condition management.
Differences require strategic alignment to ensure successful collaboration between MCOs and CBOs
While a partnership can create an excellent alliance of objectives, vision, and needed capabilities, each side has different cultures, terminology, and approaches that require alignment.
Sharing resources, skills, technology, and staff requires a level-setting between MCO and CBO to ensure that both partnership teams—in leadership, operations, and services—understand each other's perspectives and approaches. They need a shared language and respect for how their partner carries out their side of responsibilities.
Large health plans have more layers or approvals, may take longer to execute tasks, and may need more data and reporting than a CBO is used to providing. On the other hand, CBOs may need a dedicated MCO contact for day-to-day questions and leadership, as well as more in-depth support with technical, data analysis, or resource management.
Honoring these differences goes a long way to aligning culture and process while being flexible to the other's needs. The goal is to help the other achieve their goals, so both attain the overall objectives for beneficiaries and the community.
Characteristics of a successful MCO-CBO partnership
A recent panel webinar sponsored by the Health Care Payment Learning & Action Network (HCPLAN) highlighted the experiences of several MCOs and CBOs. Their insights revealed 5 characteristics of a successful MCO-CBO partnership: sharing, trust, compromise, mutual learning, and defining expectations.
- Sharing: There's a lot that needs to flow between both organizations, including data, expertise, technology, and resources. However, the less apparent aspects that should be shared, particularly from the MCO to the CBO, are power and honesty. CBOs may need some authority from the MCO, granting them power to work in the community with local government leaders or businesses. They also need to be guaranteed participant volume to ensure that the program ramps up and supports the needs of enough beneficiaries.
- Trust: This is built slowly through holding each other's confidence and being as transparent as possible for the partner's benefit. As each partner reveals, shares, makes, and keeps promises, trust deepens. For instance, MCOs need detailed progress reports, and CBOs need budget support, and trust is needed to share more sensitive information that the other requires to do their best.
- Compromise: Being flexible within reason helps both partners achieve their objectives and build strong collaboration. Over time, the partnership solidifies through give and take, honesty, and flexibility. A health plan may have stakeholders requesting specific services that a CBO isn't fully equipped to offer. The CBO must consider if they can be flexible and bring on new services to fulfill the partner's directive. Likewise, a payer may be asked to provide in-kind technical help to fill skill gaps for the CBO.
- Mutual learning: Each partner comes with expertise and know-how, but both must honor what they don't know and need to learn about each other's organization and how to partner effectively. Differences in language and terminology, processes, and working styles can either help the partnership achieve more efficiently, or it can slow it down and derail progress.
- Defining expectations: The panel featured in HCPLAN's webinar explicitly called out alignment as critical when managing expectations between an MCO and their CBOs. Payers have a lot of priorities—like HEDIS measures—and pain points. While compromise and flexibility are key to a successful collaboration, transparency around core partner expectations can avoid misunderstanding, frustration, and time waste.
If MCO and CBO can align on desired value deliverables, oversight, reporting, data, and resource sharing upfront, expectations can be more easily managed. Panelists pointed to CBOs having clarity about boundaries, capabilities, and capacity.
Also, each partner could share their top 3 expectations of each partner, the partnership, and the program.
Synergy between MCOs and CBOs can maximize investment and outcomes
A decade ago, MCO-CBO partnerships started yielding positive health and cost outcomes. These partnerships are even more necessary in response to Medicaid expansion, new VBC programs, and increasing eligibility.
As MCOs are under pressure for greater accountability while increasing access and efficiency, enhancing care quality, and improving health outcomes alongside equity, partnership with CBOs enables positive, scalable impact.
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