A new market for social care services is forming.
Health plans, hospitals, and providers are facing new requirements to screen for social needs and navigate to services. CMS has created several new financing options for healthcare dollars to be spent on non-medical services, including Medicare Advantage’s Special Supplemental Benefits for the Chronically Ill, Medicaid 1115 Waivers, and Medicaid’s authorization of non-medical benefits provided “In Lieu of Services.”
As states like California provide millions in new funding for social care services to be delivered by CBOs as part of its managed care benefit, new challenges are emerging about how healthcare and social care systems, providers, and benefits are aligned.
There is broad agreement that addressing individual health-related social needs is an essential aspect of improving overall population health and reducing the health disparities that divide our country along racial, ethnic, and other lines of identity. However, as a country we are still figuring out how to connect the healthcare and social care systems at scale.
Meanwhile, there is an influx of private capital to create new companies positioned to take advantage of this emerging market. And while start-up companies attract much needed financial resources and innovation, most do not have the necessary knowledge of, relationships with, and trust from the communities that are most in need of an expanded social care system. As a result, many of these companies fail to partner effectively with safety-net organizations.
It is essential that community-based organizations, which form the heart of our existing social care system, be an anchor and architect of the new whole-person care system that is being assembled in communities across the country.
Over the last year and a half, the Camden Coalition has been working to make this vision a reality as part of the Partnership to Align Social Care (Partnership). The Partnership is a national learning and action network working to enable successful partnerships between healthcare organizations and networks of community-based organizations (CBOs) delivering social care services.
The Partnership seeks to ensure that the existing social care system, which includes hundreds of thousands of CBOs that enjoy longstanding, trusting relationships with the communities they serve, is not left out of this new and evolving market. Instead, new systems and structures must be designed and built so that social care services are effectively aligned and coordinated with our healthcare system.
With over a decade of experience partnering with health plans and other healthcare organizations to address social needs, we are proud to participate in the Partnership alongside an impressive collaborative of leaders from government, health plans, health systems, CBOs, provider organizations, and more. The Camden Coalition has served a critical role in the Partnership with membership on the Partnership’s Planning Committee and as co-chair of the Contract Working Group. The Coalition was also contracted to develop various written products for the Partnership, including a set of principles, a description of an envisioned future state of an equitable health and social ecosystem, and work products emanating from two workgroups (Contracting and Community Care Hub).
Here are some of the highlights of the Partnership’s work thus far.
Advancing community care networks
Recognizing that the contracting process and subsequent requirements are time and resource intensive—and sometimes beyond the current capacity of many individual CBOs—the Partnership is advancing the concept of community care networks, which are a network of CBOs organized and led by a Community Care Hub (CCH). CCHs help their CBO network members participate in healthcare partnerships without having to develop all of the operational, compliance, and financial capacity required by healthcare contracts. To healthcare organizations, CCHs offer the benefits of scale by presenting a network of social care providers that can span geography, population, and service type, making contract development and administration easy.
The CCH model is already being tested at-scale across the country by the US Health and Human Services Department’s Administration for Community Living (ACL). ACL supported the development and expansion of the model and is currently operating a learning collaborative of 58 CCHs, hoping to demonstrate their efficiency in contracting with healthcare organizations to deliver a wide range of home and community-based services and supports to aging and disabled populations.
The Partnership’s CCH workgroup seeks to expand adoption of the CCH model. It just published a comprehensive guide to the competencies required of a CCH.
These competencies are organized into six domains:
- Leadership and governance
- Strategic business development
- Network recruitment, engagement, and support
- Contract administration and compliance
- Information technology and security
A recent series of webinars have highlighted the experience and best practices of advanced CCHs across the six domains:
- Leadership, governance, and business development, recording and slides
- Contract administration & compliance and information technology & security, recording and slides
- Network recruitment, engagement, & support and operations, recording and slides
Healthcare guide to contracting with CBOs
Throughout the summer, the Partnership is planning to release a four-part Healthcare guide to contracting with CBOs. This guide is funded by a subgrant from the Aging and Disability Business Institute at US Aging, which has itself created a vast array of contracting resources and toolkits for CBOs who want to contract with healthcare organizations.
Contracting with CBOs (or Community Care Hubs) is different than contracting with typical healthcare providers. In recognition of that, the guide provides best practice recommendations from members with extensive contracting experience between healthcare organizations and CBOs.
The guide covers four major elements of contracting:
- The value that CBOs can bring to healthcare organizations
- Developing the scope of work
- Designing the payment structure
- Operationalizing the healthcare-CBO partnership
While the resources were developed for a healthcare audience, CBOs and CCHs will benefit from reading and understanding how healthcare organizations approach the contracting process.
Billing and coding resources
Recognizing that the delivery and payment of healthcare is built on a system of diagnostic and procedure codes and that such codes largely don’t exist for social needs and social care services, the Partnership is also working to develop social care payment codes. This work builds on and contributes to important work being done by the Gravity Project to define a universal set of data standards for integrating social needs data into clinical care.
The Partnership is developing a crosswalk of billing codes for social care services; identifying best practices for use of Z codes by community providers; and creating labor codes for care coordination and social needs screening and assessment activities. These products, which will be released over the summer, are important contributions to the field.
These foundational tools are only the beginning. The Partnership will continue to support equitable healthcare/CBO partnerships in communities across the country. We expect to learn and share even more as this market continues to grow and mature.
We have an opportunity right now to build the scaffolding for ecosystems of care that are truly rooted in and responsive to the communities they serve — but this window won’t be open for long. We and our collaborators in the Partnership to Align Social Care believe that leveling the playing field between the health and social sectors is not only possible, but the best solution to address people’s intertwined health and social needs.