Common goals. Trust. Mutual commitment. Those are a few of the terms that immediately come to mind when we think about collaborative relationships. When it comes to partnerships between hospitals and other providers and community-based organizations, though, the reality is too often something different: a lack of clear communication, unequal roles, and one-sided leadership.
That's a significant catch when the new building blocks of health care reform—patient-centered medical homes, value-based payment, and more—increasingly recognize the importance of “social determinants of health,” and look to community-based organizations to help address those factors, while also helping patients understand their health conditions and better manage them.
With some 16 years of experience at the intersection of health care and aging services, UHF sees the promise that such partnerships hold for advancing the health of all age groups and special populations. And we've learned quite a lot about what's needed to deliver on that promise.
First, it's important to understand how the two sectors differ. Not surprisingly, health care providers are typically far larger, more complex organizations, with multiple sources of income. Community-based organizations, or CBOs, tend to have flat management structures, thin operating margins largely based on government contracts, and limited resources and capacities, especially related to technology. Health care is highly regulated in terms of professional standards, whereas rules governing CBOs tend to focus on operations—delivering meals or other services, for example. Most important, health care providers are increasingly responsible for outcomes—improved health of not only individuals but also populations—while CBOs have generally been expected to report units of service provided, not necessarily impact.
While health care is inexorably moving toward a focus on population health and outcomes, community-based organizations are still largely responding to individual seniors' crises but not anticipating and addressing the risks, strengths, and needs of the larger client population, now and down the road.
Those differences contribute to a lack of understanding between the sectors about how the other functions, and explain, in part, why they're only starting to recognize that they don't speak the same language, even when using the same words.
So how do health care's and CBOs' distinct capabilities and ways of functioning affect their work together?
Although there are many ways for organizations to interact with each other, true partnership requires shared purpose; alignment of goals that fit each organization's mission and capabilities; shared responsibility for success; and accountability to one another. If these four elements aren't there, then what exists is not a partnership but something else: perhaps a contractual relationship built on a CBO's provision of a specific service, like meals or transportation, or a collaboration in which resources or services are shared or co-located, and populations served may or may not overlap, or part of a coalition, a broad multi-organizational effort to change something in a community. All of these are important—but they're not “partnerships” per se.
This isn't just semantics. As New York moves ahead with the Delivery System Reform Incentive Payment program, for example, more than 300 community organizations have signed on as “partners” in the Performing Provider Systems that are facilitating collaborative projects to improve care and population health. Will those CBOs have a voice in shaping the work of those projects, which aim to be models for widespread health care transformation?
CHARTING A WAY FORWARD
To have a forthright exchange and true partnership with their clients' health care providers, community-based organizations have to become targeted and systematic in how they serve their clients, and be able to demonstrate their effectiveness.
In the coming year, UHF's new Health Indicators–Performance Improvement project will build on our earlier efforts to help CBOs do just that. We're making data collection and implementation more flexible for them so they can develop interventions to match their capacities and produce measurable results.
We're confident that we'll be making a real difference—in much the way that our Together on Diabetes–NYC project elicited documented improvements in seniors' abilities to manage their disease. That's one step on what may be a long path; we will keep scanning the landscape to identify other opportunities for bridging the health care/community partnership gap, and bringing them to fruition.