Across the country, efforts are underway to better align social and health care delivery systems, create partnerships with community-based organizations (CBOs) to coordinate and deliver services that address health related-social needs (HRSN), and establish sustainable payment mechanisms that support efforts to address HRSN. CBOs have long histories identifying and addressing community member non-medical needs and have established trust as community service providers.
While large and well-resourced CBOs may have an infrastructure in place to partner with Medicaid managed care organizations (MCOs), smaller CBOs are less likely to have the capacity or experience to enter into contractual relationships, be able to take on financial risk, or have the capability to build staff skillsets and bandwidth. For MCOs, contracting with multiple CBOs to provide HRSN services can create several challenges — such as the time and expense to execute contracts with multiple CBOs, maintaining fidelity to programs and services across multiple providers, and ensuring data and security compliance.
In response to the increase in demand for CBOs to play a more direct role in care delivery, CBOs have begun to develop networks and experiment with organizing frameworks for “backbone” functions like care coordination, planning and evaluation, health information technology, and training. To assess the state of CBO network formation in Texas, and to better understand CBO strengths and capacity needs, the Center for Health Care Strategies and Treaty Oak Strategies, with support from the Episcopal Health Foundation, conducted key informant interviews with Texas MCOs and CBOs. This report explores the various types of CBO partnership models emerging in Texas to address Medicaid members’ HRSN, and provides summaries of current partnerships in select cities and regions.
While focused on the Texas context, lessons herein can inform activities in other states to better address the HRSN of Medicaid populations.