ARCH: Setting Strategic Priorities with MACC

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.

MACC

MACC is a collaborative network in Minnesota composed of 50 human-services nonprofits addressing housing, food insecurity, mental health, education, and more. Some of MACC’s network characteristics are that it’s regional, focused on a wide range of local issues, and multi-service.

Goal and Vision: MACC’s goal and vision as a network is to help secure healthcare contracts as the intermediary on behalf of members to streamline both contract negotiation and data-system processes. MACC hopes to help member organizations adapt to the demands of healthcare contracts secured by MACC by quickly sharing learning across the network. 

How the network’s operating environment influences its strategic priorities

MACC has been around for 20 years and its systems, culture, and ways of working are rooted in a long history and a member-driven strategy. Similar to EngageWell, MACC’s long history has made it in many ways the institutional memory for its members, but MACC is also pushing themselves to look beyond how things have been done in the past as they think about defining strategic priorities. 

“It can be challenging to ask, “How would we approach this is if we were starting over again right now?” rather than, “This is the structure we have, so how can we tweak it?”” –Lisa Thirer

Because MACC hasn’t had any direct competitors, the network’s priorities and subsequent capabilities have progressed carefully over time, and in collaboration with member needs. Having member buy-in and trust is necessary, so MACC has had to grapple with when being risk-averse is beneficial versus when it might be holding the network back from evolving with healthcare changes. 

MACC’s business model is structured to provide a multitude of back-office support (e.g., contract management, medical billing, finance support, IT/facilities, data management, etc.) that members can choose and pay for a-la-carte. This means that MACC’s financial health is directly impacted by the financial health and/or budget sizes of their members. So, while MACC’s business model doesn’t need healthcare contracts – they’re not beholden to operating only within the confines of healthcare contracts like other networks might be – they understand the huge opportunity that healthcare contracts can offer their members.

“MACC recognizes that they need to identify priority investment areas and change their business model over the long term to be effective as an organization, and to be effective toward its members.” –Lisa Thirer

Challenges to manage when setting network priorities

1) How do you navigate the current healthcare landscape and how to best plug into it? 

“MACC came into the healthcare space incredibly well-positioned from a social capital perspective and with a wealth of data expertise. Building on that, they now need someone with dedicated capacity to study the healthcare landscape and how MACC and its members can best plug into it.” –Elise Miller

2) How do you manage growth as a network?

• One of MACC’s strengths is creating implementation processes and data systems; however, members can’t necessarily afford to pay for all the services that could benefit them and currently there isn’t financing available through MACC or other local funding sources to help bridge this gap.

3) How do you articulate your value-add and strategic priorities to both healthcare and members, especially as they evolve and iterate in real-time? (Read how EngageWell is grappling with a similar question.)

• MACC has been focusing on defining their role and responsibilities within a healthcare contract, so that they can clearly articulate their value and how that benefits members and payors.
• There are additional considerations that come with having a network that addresses a wide range of social issues in the community, rather than focusing on one or two (e.g., ending homelessness and/or addressing food insecurity). MACC’s value proposition is based on the strength of the network’s systems and operations, not the clinical or community services that are delivered. While there are benefits to this approach, such as network-wide investments in the infrastructure to strengthen data-sharing capabilities, there are also challenges associated with creating new partnerships across service providers for each contract opportunity.
• One challenge has been keeping members up to speed with new or redefined strategic priorities and continuing to get buy-in during times of growth or change.

“A lot of our work with MACC has been helping them to be really clear about their priorities internally and with members because you can’t get to that value proposition for healthcare unless first you have that trust and buy-in from members. It’s also critical to think about what you want to look like as a network and what you need in order to deliver value to healthcare.” -Elise Miller

4) What does it take to understand the impact and full cost of contracts, and what it’s really going to take to deliver on the contract (including the financial implications for you and your  members)?

• Both MACC and EngageWell already have experience advocating on behalf of their members in conversations about contracts to make sure that more of their full costs are covered; in a recent exchange about a home visiting contract, MACC requested compensation as the network lead for the time it would take to manage data integration.
• MACC will be doing full cost modeling and cohort-level analysis to identify the cost for each organization to deliver on healthcare contracts.

“For networks, 'knowing your full costs' means understanding what it takes to operationalize something for the network and its members. It’s a two-part process: first understanding the mechanics of what it’s really going to take to deliver on a contract, and second, how to access the financial impact on members." –Lisa Thirer

Other actionable takeaways for CBO networks

“Health partners are still learning about how differently nonprofits operate, and service providers are still exploring how to fit into the national landscape of healthcare. It’s been impressive to see how different players are able to collaborate while building this knowledge of the field.” –Martin Lenarz-Geisen

• Understand healthcare better—the vocabulary, landscape, and motivations. It will be time well-spent towards your partnership efforts. Make sure there’s dedicated capacity – either through staff or a consultant – to stay on top of what’s happening in the healthcare landscape locally and nationally, how the network’s offerings fit within/add value to that landscape, and what it will be like to partner with healthcare. Come to conversations with healthcare partners ready to talk about your network’s value add and full costs as part of how you articulate your networks’ place in the healthcare landscape.
• Prioritize frequent, transparent communication. Make sure that as a network, you can provide members with a clear understanding about what healthcare contracts will require, both operationally and financially from their businesses. Clarify, define, and communicate strategic direction and/or priorities early and often both internally and with healthcare partners to maintain and build trust. 

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