Money Moves the Mare: The Response of Community‐Based Organizations to Health Care's Embrace of Social Determinants

Abstract

Health policies that encourage health and social integration can induce community-based organizations (CBOs) to adopt new ways of working from health care organizations, including their language, staffing patterns, and metrics. These changes can be explained by CBOs' perceptions that health care organizations may provide new sources of revenue. r While the welfare implications of these changes are not yet known, policymakers should consider balancing the benefits of professionalizing CBOs against the risks of medicalizing them. Context: Recent health policies incentivize health care providers to collaborate with community-based organizations (CBOs), such as food pantries and homeless shelters, to address patients' social determinants of health (SDOH). The perspectives of health care leaders on these policy changes have been studied, but the perspectives of CBO managers have not. Methods: Our research question was: How are CBOs in Massachusetts perceiving and responding to new Medicaid policies that encourage collaboration between health care organizations and CBOs? We interviewed 46 people in leadership positions at CBOs in Massachusetts for approximately an hour each. We analyzed these data abductively, meaning that we iterated between inductively coding transcripts and consulting existing theories and frameworks. Findings: We found evidence of a knowing-doing gap among CBOs. Even though CBOs value their distinctiveness and autonomy from health care, they

Multistakeholder Perspectives on Data Sharing to Address Patient Food Insecurity

“…Information on the perspectives of all 3 of these stakeholder groups is scarce, and yet the active involvement of each is essential for successful interventions to address FI in health care settings. 23 In this article, we share findings regarding multistakeholder perspectives on data sharing for the purposes of FI screening and referral in primary care settings located in rural and smaller town locations.…”

Health Care and Community-Based Organization Partnerships to Address Social Needs: Medicare Advantage Plan Representatives’ Perspectives

“…CBOs may not necessarily have previously needed to provide evidence of the population health or financial impact of their services to medically oriented health care entities. CBOs are, in fact, charitable organizations that are quite separate from a profitoriented business model or the layers of government regulations that MA plans face, and have their own ethical and legal standards which MA plans may not be familiar with (Taylor & Byhoff, 2021). A recent qualitative study of CBO representatives found that CBOs value and seek to maintain their distinct missions and community focus, but financial incentives lead some CBOs to make organizational changes to better match the structure of health care organizations (Taylor & Byhoff, 2021).…”

“…CBOs are, in fact, charitable organizations that are quite separate from a profitoriented business model or the layers of government regulations that MA plans face, and have their own ethical and legal standards which MA plans may not be familiar with (Taylor & Byhoff, 2021). A recent qualitative study of CBO representatives found that CBOs value and seek to maintain their distinct missions and community focus, but financial incentives lead some CBOs to make organizational changes to better match the structure of health care organizations (Taylor & Byhoff, 2021). Moreover, recognition of the importance of addressing social needs, along with the rise in value-based care, has only recently expanded opportunities for meaningful cross-sector collaboration that requires traversing of these organizational differences.…”

“…Partners should also be cognizant of the organizational harms that can result from these partnerships. One study of CBO representatives found that CBOs are concerned that partnering with health care organizations can lead to a loss of autonomy and to an overmedicalization of their goals and services (Taylor & Byhoff, 2021). Just as CBOs have expertise on providing community services that can be leveraged by payers and providers, these health care entities have advanced knowledge on data management and measurement that CBOs can leverage to scale up and evaluate their services.…”

Increasing Capacity for Evaluation of Community-Based Organizations: Lessons from the Ohio Equity Institute

“…8 To participate in these efforts and support partnerships with health care organizations, it is important for CBOs to build evaluation capabilities both to guide their own efforts as well as to demonstrate to funders and other stakeholders that they are effectively implementing evidence-based interventions. 9 Research suggests that building evaluation capacity, or the ability to perform evaluations, requires CBOs and their staff to buy into the importance of evaluation, commit sufficient resources to collect data, and collaborate with external researchers to develop sustainable evaluation methods. [10][11][12][13] Previous efforts to strengthen internal evaluation capacity have centered on providing CBOs with onsite technical assistance, developing evaluation skills through training programs, and offering interactive web-based systems to guide evaluation design.…”