The intensifying focus on social determinants of health and value-based payment is driving new relationships between healthcare providers and community-based organizations.
People who are high utilizers of healthcare services often have complex medical, behavioral and social needs. The social determinants drive more than 80% of health outcomes. Yet up to 88% of the U.S. healthcare budget goes to providing medical services, leaving many patients' needs unaddressed as they stay in a cycle of requiring more clinical care.
Today, healthcare providers are looking at the capacity that community organizations have to address their patients' social needs and work alongside them to improve population health. This interest has been heightened by New York becoming the first state to require value-based payment contractors to implement at least one social determinants intervention and include a minimum of one social/human service agency.
Value-based payment arrangements have given community organizations access to new revenue streams that are theoretically more sustainable than the grants and contracts they have traditionally relied on. However, the community organizations are being asked to generate evidence of their programs' effectiveness in terms of population health (e.g., asthma morbidity reduction, improved diabetes control, reduced emergency department visits and readmissions, etc.) and even pricing (e.g., reduced price of service per member per month). They need to gather data and translate their outcomes in a way that is relevant to the healthcare organizations.
Through our work in Delivery System Reform Incentive Payment, or DSRIP, in New York, we saw this need in working with our member community organizations. Bronx Partners for Healthy Communities is a DSRIP Performing Provider System led by SBH Health System, a safety-net hospital in the South Bronx, an area that endures many of the worst socio-economic and health disadvantages in the state.
Our community organizations provide valuable social services to the community working with lean budgets and staff sizes. We came to understand their challenges in generating meaningful, health outcomes-oriented information that has not historically been required.
To address this need, we developed a nine-month training course that we provided to nine organizations. The curriculum addressed the core principles behind assessing program impact and value, including principles of program evaluation, constructing logic models, understanding existing data types and ways of collecting new data; how to think about and identify proxy values; how to link indicators (outputs) and outcomes/impact, how to use data to communicate program value and impact; and how to leverage other collaborators' data to complement their own.
The course and individualized technical assistance were well-received by the community organizations as much-needed and highly effective in helping them generate tangible evidence of their programs' impact that helped them enhance their strategic planning, create effective grant proposals, and develop actionable organizational overviews.
The community organizations moved away from being compliance-based and using existing data only. They observed notable growth in program planning and evaluation capacity and a culture shift toward sharing data within the organization. They took a more entrepreneurial approach toward collecting data that is program-led and drives quality improvement.
Data use was welcomed as necessary for an indicator of success rather than an intimidating burden that was only used to "check the box."
Many community organizations were able for the first time to access medical records and utilization data through Medicaid membership information. We demonstrated how making use of other existing data from their clients without engaging in new data collection directly could add substantial value to how they characterize their organization's work and effects.
They found that staff capacity and leadership buy-in to this process were critical. Those community organizations that had the capacity to connect with an existing electronic health record system or the regional health information organization found the processes protracted and laborious without dedicated resources and expertise.
The training raised issues about how data was collected in their organizations, the challenges of engaging already burdened staff members in new data collection, and how data was collected and shared between related programs.
Some community organizations found that their programs did yield robust data or that their outcomes data was owned and held by another data clearinghouse or program management organization. We worked with them individually to address such challenges with data identification and collection and provided alternate strategies.
Across the board, these community organizations learned the importance of communicating their data-driven findings effectively and succinctly, and within the context of the healthcare sector. They understood the need to hone their ability to develop organizational pitches and communicate data-rich presentations detailing their program outcomes.
The move toward value-based payment is a critical opportunity for healthcare providers and community organizations to provide the comprehensive care that high-utilizing patients need to improve their health. Patients will only begin to benefit when community partners have the knowledge, tools and capacity to develop and communicate the outcomes data to help them fully engage in value-based payment.
