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Teaming up with community-based organizations for SDOH work

Health systems should work alongside community-based organizations to outline specific roles in their teamwork on social determinants of health projects and programs.

The work to address social determinants of health is a team effort. While healthcare organizations might see themselves as leaders of emerging population health initiatives, the strength of these programs comes from teamwork with community-based organizations.

After all, CBOs specialize in boots-on-the-ground work addressing SDOH and have the deep-rooted community knowledge to make social services accessible, according to Bryan Buckley, DrPH, MPH, the director of health equity initiatives at the National Committee for Quality Assurance (NCQA).

"SDOH work is a team sport," Buckley said in an interview. "As we think about community-based organizations, healthcare organizations and public health institutions, there are quite a lot of different players in these spaces. It requires that team-sport mentality that healthcare organizations can't solve all these things for themselves. They're not designed to do that, and that's okay. This is where partnerships are truly important."

Healthcare organizations have become increasingly dialed into SDOH as the industry has emphasized the importance of whole-person care. Payment models have shifted from volume to value, and with that, healthcare stakeholders have stressed the importance of preventive care and well-being.

Armed with the knowledge that medical interventions only account for about 20% of individual health, uncovering and addressing SDOH has become paramount. Right now, healthcare providers are weighing SDOH as part of their clinical decision-making around 35% of the time, per an Annals of Family Medicine report, and that number's only slated to grow.

As many as 73% of healthcare stakeholders said they expect their organization's health equity and SDOH strategies to continue to ramp up, according to Ernst and Young's 2024 "Health Equity Outlook Report."

As more payment models require hospitals and providers to report on and address SDOH, they will need the right tools to ensure they understand a patient's social needs and are able to address them, Buckley said.

And that's going to require a good team out in the community.

Financial and social capital in exchange for SDOH insights

Buckley explained that "CBOs are often the people who are closer to the problems patients have and hear those stories in a more crystallized way. They understand not just the person's physical health, but also their social connection to the community, their wellness and their financial health. Those are some really deep insights that can help healthcare organizations think about their interventions in more unique ways. CBOs can also help facilitate and drive some of those upstream forms of care."

But creating a roster of CBOs to address health-related social needs isn't as easy as a schoolyard pick.

Healthcare organizations, fueled by their own motivations, need to navigate the capabilities and needs of potential community-based partners. At the same time, they need to assess, understand, and acknowledge the unique strengths CBOs bring to the team.

Indeed, hospitals and health systems are in the power position here, Buckley indicated. Healthcare organizations have a lot of financial and social capital, and that can put them in the driver's seat for a lot of SDOH decision-making. But to recruit and maintain a strong field of CBO players, healthcare organization leaders need to keep an open mind.

"It's a multi-party negotiation, and anyone that's looking at negotiation theory, there's really the idea of how do we make the pot bigger? How do we create more value, that there's no zero-sum?" Buckley said.

"It's understanding, what are the pebbles in people's shoes for healthcare organizations?" he continued. "When you think about diabetes, for example, when you think about food and wellness, those are things that patients want to do. They just don't have the resources or time. And frankly, when healthcare does it, it will cost a lot more than if that's something that community-based organizations might want to do."

Hospitals and health systems need to capitalize on and be transparent about the resources they have that CBOs could benefit from. For example, cash-strapped CBOs are often open to tools that might make it easier for them to get better grant funding.

"When it comes to a lot of grant contracts or funding opportunities from foundations, they're looking for data," Buckley noted. "And as we can strengthen those data infrastructures for community-based organizations, that's something that's a really big motivation for them to scale up their efforts, understand and pilot test new initiatives and really scale these new initiatives."

CBOs can also benefit from different exchanges of capital that health systems bring to the table as anchor institutions. Thought leadership and intellectual capital, plus providing insights into how health systems think, are always helpful for CBOs, Buckley pointed out.

"There's also political capital where healthcare may not necessarily be able to fix anything, but they can also be an advocate for community-based organizations," he added.

Healthcare organizations also have the influence to pull in CBOs to be a part of boards and committees, setting CBOs up to solve some of the biggest challenges communities face.

"There's this exchange of information and exchange of capital really helps both organizations and unique ways," Buckley pointed out.

Guides to facilitate long-term CBO partnerships

Getting on the same page about the mutual benefits of a health system and CBO partnership is only half the battle. An ongoing partnership requires a good understanding of both parties and mutual respect, Buckley said.

To that end, NCQA recently launched two key resources about CBO partnerships tailored to healthcare stakeholders and CBO leaders. The guides serve as a how-to for the different types of entities based on their unique perspectives and goals.

"How do you build those equitable partnerships? How do you think about that mutually beneficial agreements and what the different forms of agreements could look like? How do you sustain those partnerships?" Buckley queried, outlining some of the topics included in either resource.

The resources go into the nitty-gritty of different facets of a CBO partnership negotiation, including translating different verbiage either organization might use and how that applies to the other. But the overarching themes look at how CBOs and health systems can maintain their teamwork for the long haul.

Expectation setting, for example, will be paramount. What will either teammate be responsible for, and what will communication look like?

Health equity is a team sport.
Bryan Buckley, DrPH, MPH Director of health equity initiatives at the National Committee for Quality Assurance

"How do we think about shared decision making, and what do we think about metrics of success for healthcare organizations? What is the metric for success? Some people are looking at the social needs measure for HEDIS, and that is their motivation from the healthcare delivery side or the health plan side. Meanwhile, the CBO might say, 'I'm looking to make sure maybe people have access to good food and at low cost.'"

Buckley also advised healthcare organizations and CBOs to work together to agree on data sharing and eventual program funding for a certain initiative. Both parties should contract what types of data they will share with each other and how to do so securely. It will also be prudent to review and agree on grant funding contracts moving forward.

At the end of the day, healthcare organizations and CBOs need to recognize their shared goal in spite of any potential differences in process and language. In doing so, they can get on the same team and work toward that end. But that will require working together, not alongside each other, Buckley said.

" What's the story that we're going to tell of ourselves of the future, but more important, what's the story that others are going to tell about us? When it comes to healthcare organizations, what's the story that community-based organizations are going to talk about?"

Will CBOs say a health system truly saw them as partners and worked to understand where they could have a shared impact? And will health systems say a CBO was a collaborative partner that appreciated the ramifications and complexities of healthcare?

"The idea is we do need to work together," Buckley concluded. "Health equity is a team sport, and it's very important that we see each other and see the challenges that we all have, but then look at where there's shared opportunity to move this work forward."

Sara Heath has been covering news related to patient engagement and health equity since 2015.

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