Health / Nonprofit Sector

Questions ARCH Networks Are Asking Themselves To Find Their Why

May 11, 2020

The healthcare system, from Medicaid to private insurance payors to hospital systems, is increasingly recognizing that we have to pay attention to the factors that affect patients’ health outside of the doctor’s office. These factors ‒ from access to healthy food to mental health treatment to stable housing ‒ are collectively referred to as the social determinants of health, or the extremely catchy “SDOH” for short. Nonprofits, also called community-based organizations (CBOs), have been in the business of addressing these SDOHs for decades. Healthcare is increasingly asking whether and how it can rely on CBOs to help take care of their patients’ health in an integrated way, beyond medical facilities.

One problem that often arises is scale. Healthcare institutions are typically much larger than CBOs, and so there is a mismatch: a healthcare payor might serve 50,000 people annually in a metro area, whereas a CBO might serve 1000. It is difficult and time-consuming for healthcare institutions to develop and manage relationships with myriad smaller CBOs. Increasingly, CBOs are forming networks, so that they can engage with healthcare at a collective level. This helps to even the playing field in ways that can benefit both sides, not to mention the clients/patients.

There can be many advantages to forming or joining a CBO network, from integrating and improving client care, to increasing the likelihood that your message about what it will take to transform health in your communities will be heard by those who have the power to make those changes. But we have learned in our ARCH work to-date that it's also challenging to coordinate within the network itself, on everything from data to referrals to payments. In fact, the time and resources required for a single CBO to coordinate with a healthcare partner haven’t gone away, they have just shifted: the CBOs are working deeply with each other within the network itself to present a unified “front” to their healthcare partner. Governance and integrating data systems continue to be expensive and time consuming, wherever they sit.

We have also seen that creating a shared vision upon which to build an integrated partnership with fellow CBOs, and with healthcare, is an iterative process. The CBO networks are all balancing the push to secure a healthcare contract with the pull to ensure that client health is front and center, while continuing to build trust among all the stakeholders. Not everyone is focused on the same priorities at the same time. So sometimes revisiting the reason for the collaboration, and reminding each other why you are working as hard as you are, is important.

If your CBO is considering joining or forming a network, it’s important to be explicit about the “why” and to go in with open eyes about the work that it will entail. And don’t be surprised if you find yourselves asking and answering the same questions repeatedly as you build your network; this kind of iterative process is normal and necessary in building a complex partnership. Here are some of the questions that we’ve heard our network leaders and members ask themselves and each other about working together. We offer them as a starting place for your own conversations around partnering:

  • What, in simple terms, do we most hope to get out of partnering with each other, and with healthcare?
  • Are we a coalition of the willing, or a coalition of the “afraid to miss out”?
  • What does success look like for us?
  • Who, specifically, are we planning to serve? How will their health improve because we serve them via a network?
  • What do we excel at, as individual CBOs and as a network, and how can we leverage that strength in partnering with healthcare?
  • What can we measure to demonstrate our value? What can’t be measured but we know is critical to our clients’ health?
  • How can we communicate the value of our members and of the network itself to potential payors in ways that resonate?
  • How do we play well in the sandbox with our partners, some of whom have perhaps been competitors?
  • How do we get smarter about our healthcare partners’ business and all the wonky policies that will affect us?
  • What is our business plan as a network? What portion of our full costs are healthcare payors likely to cover? If there are gaps, how will we fill them?
  • What investments do individual members and the network need to make to integrate?
  • How much does it cost the network, and its members, to serve clients?
  • What do we (honestly!) need to get better at and how can we do that? What can we learn as we go versus what do we need to have figured out up front?
  • And perhaps the hardest question to answer, what will we say no to?

Want to hear directly from our ARCH networks? Here’s a video of our partners asking themselves these questions.