Health / Nonprofit Sector

ARCH: Setting Strategic Priorities with EngageWell IPA

May 11, 2020

Advancing Resilience and Community Health (ARCH) is a project to help the burgeoning relationships between healthcare institutions (payors and hospital systems) and community-based organizations (CBOs) get off the ground successfully and at a scale that will make a difference. NFF has been partnering with three networks – EngageWell IPA (New York), Metropolitan Alliance of Connected Communities (Minnesota), and Thomas Jefferson Area Coalition for the Homeless (Virginia) – to explore what it takes for networks of CBOs to come together and partner with healthcare. NFF prepared a blog series for each network to share reflections from staff involved with ARCH (Lisa Thirer, Deirdre Flynn, Sophia Raday, Meadow Didier, Elise Miller, and Martin Lenarz-Geisen) to share what we’ve learned from defining scopes of work and delving into strategic priorities for each network. Though each network has a unique set of characteristics, all captured in this network snapshot, there are actionable takeaways that anyone can apply no matter the structure, size, or other characteristics that might define a network’s approach.

EngageWell IPA

EngageWell IPA is a network of community-based providers in New York City that offers comprehensive, integrated services to address complex medical and behavioral health needs and unmet social determinants of health, including food, housing, and economic insecurity, for people living with substance use disorder and/or HIV/AIDS. This blog shares some of what our NFF team has learned from working with this New York-based Independent Practice Association (IPA) that is actively working to develop a contract with healthcare.

Goal and Vision: EngageWell seeks to provide comprehensive, place-based services rooted in the philosophy of client-centered, trauma-informed care and harm reduction to those whose complex conditions are better met through a collaboration of service providers. EngageWell’s goal is to achieve collective, value-based contracting with healthcare providers for its member organizations to address the social determinants of health for its clients.

How the network’s operating environment influences its strategic priorities

EngageWell grew out of the specific needs of a time and place: its organizations were born during the HIV/AIDS epidemic in New York City in the 80s. They have since evolved to serve a broader set of needs, from harm reduction to mental health.

“EngageWell is essentially asking themselves: How do we stay true to our core values and to the services we provide, while also recognizing that there’s a lot more that we can do?” -Elise Miller

EngageWell is an interesting hybrid; they are a start-up in one sense, operating in a new structure and policy context. But at the same time, they’ve known each other for a long time, have existed in some way as a network beforehand, and have deep relationships in the healthcare community. This creates some tension between the push of doing new things and the pull of legacy values and activities.

“EngageWell has a history and things they don’t want to stray from. They also have a new opportunity available through policy changes; marrying those two things is really hard.” -Elise Miller

Their current opportunity is largely shaped by the policy and priorities of NY State.

“EngageWell formed as an IPA in part because there were financial incentives from the state to do so: the IPA positioned them to get large behavioral health contracts. Their legacy structure was an organic response to the HIV/AIDS crisis in New York and the state's Ending the Epidemic (EtE) initiative: they focused on harm reduction services for injecting drug users and community advocacy on behalf of Health Home care coordination services.” -Lisa Thirer

Challenges to manage when setting network priorities

It is no small task to coordinate at both a strategic and tactical level the priorities and activities of a multi-organization network, with members of all different sizes and services, albeit serving clients with similar needs. Early priorities for EngageWell included gaining consensus on and refining its value proposition, developing a coordinated clinical model of care, and understanding its data analysis and sharing requirements and the infrastructure investments to support these needs.

1) How does a network collectively determine its value? (Read how MACC is tackling a similar question.)

  • The tension of simultaneously being a start-up and a long-established collaboration has made it vital that EngageWell dig in and understand its core: who it’s trying to serve, the aim of its work, and why its network does it better than others. The network has also invested in deeply understanding the goals of its potential healthcare partners, and that has helped shape its value proposition and increase its readiness to contract. EngageWell is now able to articulate to healthcare partners how it is the network best suited to serve their members.
  • The lesson for other CBOs considering joining or forming a network is that it will be harder to develop a value proposition if your services aren’t around a unifying issue, such as harm reduction or eliminating local homelessness. Do your best to find a common theme that can become your north star: whom you serve in the community and why. Being as specific as possible will make it easier to talk about how your services can make a difference, and to identify your unique value-add. This is compelling to healthcare, whereas saying you serve everyone in every way is a harder sell.

2) What do you need to measure, for yourself? For your partners/funders? And who will pay for it? 

  • Value-based healthcare partnerships require the ability to measure outcomes. Gathering, analyzing, and sharing data in a way that protects patient/client confidentiality is a monumental task that requires resources. It’s also important to recognize that you may not be able to measure everything, nor isolate the specific parts of the intervention that were key to your clients’ successes.

“It’s vital to establish what you’re going to measure and how you’re going to do it. Are you being asked to measure something complicated in a value-based world at others’ behest, or are you able to measure outcomes that you determine? And who’s paying for the measurement work: it’s not a small lift! It is ideal to first understand what you need to measure—for yourself and your partners—so that you can invest wisely in measurement efforts.” -Lisa Thirer

Other actionable takeaways for CBO networks

  • Do a thoughtful budget for the network. Think of your one-year budget as a mini strategic plan. It’s a forcing mechanism to determine where you’ll prioritize spending your money. And it will also show you where you need to get funding to build capacity or infrastructure (if you need a referral system, coordinator, shared evaluation system, etc.).
  • Understand the full cost of services, but at the right time. You need to know the full cost of your services; NFF recommends doing this analysis up front. However, we also recognize that learning while doing is sometimes a more realistic approach. You may decide to enter into a pilot contract with healthcare without knowing full costs; such a contract is a form of R&D, which is a necessary, but often unfunded, expense for any organization. If this is the case/your circumstance, use the pilot to figure out your full cost of delivering what’s being asked of your organization. When you then move to a larger contract, you can set your pricing to cover that full cost, which is the only way your organization will be sustainable. Do the exercise of understanding and accounting for everything from programmatic staff and supply costs, to the rent on the building that houses the programs, and the evaluator to capture your impact data required by your healthcare partnership. And don’t forget those sometimes hidden costs, like needing to replace donations, or the volunteer labor you rely on with paid staff, in the case that either become unavailable.
  • Invest in understanding the healthcare policy environment. The healthcare policy landscape is complex and ever-changing, and the vocabulary of healthcare may be unfamiliar to most CBO employees. If your network wants to successfully partner with healthcare, you may need to invest in expert advice. Understanding healthcare, especially the policy landscape, is the first step in advocating for contracts that make sense for your network and network members, and, ultimately, advocating for the policy changes necessary to best serve the populations you care about.
  • Be clear on your network’s goals for a healthcare partnership. Take time to articulate and agree upon your network’s reasons for entering into a partnership with healthcare. Beyond revenue, what do you hope to get out of it? Will it better serve your clients? Help you reach new clients? Something else? And, if the terms of the partnership won’t sufficiently achieve your goals, or if they come at a cost that will be destabilizing for the CBOs in your network, consider whether you should move forward with the partnership or walk away.

For more insights, see how MACC and TJACH are delving into their strategic priorities.