It Takes a Village: A Descriptive Study of Partnerships between Medicaid Managed Care Organizations and Community-Based Organizations to Provide Whole-Person Care

Document Type

Presentation

Presentation Date

6-16-2021

Abstract or Description

Research Objective:

Motivated by the need to improve member health and reduce health care spending, and recognizing the impact of social determinants of health (SDOH) on member health outcomes, Medicaid Managed Care Organizations (MMCOs) have increased efforts to address the social needs of Medicaid beneficiaries – often leveraging community-based partnerships to support such efforts. The purpose of this study was to describe how MMCOs prioritize, develop, and sustain community-based partnerships to mitigate the adverse impacts of SDOH on member health status and healthcare utilization.

Study Design:

Data for this qualitative study were obtained from interviews with 26 MMCO representatives, including senior executives, medical directors, case management directors, and directors and staff of dedicated plan programs to address social needs of members. Interviews were audio-recorded and transcribed, and transcripts were then analyzed using thematic analysis.

Population Studied:

Study participants were representatives of eight national and regional MMCOs across nine state markets who were involved in prioritizing, developing and/or implementing their organization's SDOH efforts.

Principal Findings:

Participants unanimously stressed the importance of establishing and sustaining community-based partnerships for the purpose of addressing the social needs of Medicaid beneficiaries. Such partnerships were necessary, partly, due to the limited capacity and expertise of MMCOs to tackle social issues effectively and efficiently.

MMCOs reported partnering with typically small, community-focused and community-based organizations (CBOs) to address members’ social needs. Forged partnerships span across several focus areas including food insecurity and nutrition, maternal and child health, education and youth development, housing and homelessness, behavioral health and substance abuse treatment, employment and workforce development, and legal assistance.

MMCOs considered the following information when prioritizing CBO partnerships: (a) member and community need; (b) strategic priorities of the MMCO; (c) state expectations ; (d) CBO scope, capacity and readiness to engage in healthcare delivery; and (e) the extent of CBO ties to the community. The management of partnerships was centered on a process of grassroots community-centric relationship building, with partnerships formalized using various contracting strategies to facilitate member data sharing and enhance service provision.

Partnerships with CBOs were described as creating a “win-win-win” situation for Medicaid beneficiaries, the MMCO and the CBO. Successful partnerships facilitated the provision of needed social services to members, resulting in improved health outcomes at lower cost. MMCOs also leveraged CBO partnerships to extend their own capacity to meet member needs and enhance community visibility and reputation. Finally, partnering with MMCOs allowed CBOs to expand organizational capacity to accomplish their mission and build infrastructure for engaging in healthcare delivery in future.

Relationship building, long-standing commitment to the partnership, and tailoring the partnership to suit CBO capacity were identified by participants as being essential for sustaining community-based partnerships.

Conclusions:

MMCOs prioritize community-based partnerships based on need, stakeholder expectations and CBO capacity and readiness. Partnerships are managed and sustained through community engagement and relationship building.

Implications for Policy or Practice:

The study findings highlight the importance of inter-sector collaboration involving CBOs in ensuring the health and well-being of Medicaid beneficiaries, and may inform future policy efforts targeted at realigning the existing healthcare delivery system in support of the provision of “whole-person” care.

Additional Information

Georgia Southern University faculty members, Samuel Opoku, Charles Owens, Linda Kimsey, Bettye Apenteng, William Mase, and Angela Peden co-presented It Takes a Village: A Descriptive Study of Partnerships between Medicaid Managed Care Organizations and Community-Based Organizations to Provide Whole-Person Care in the American Public Health Association (APHA) Annual Conference, June 2021.

Sponsorship/Conference/Institution

American Public Health Association (APHA) Annual Conference

Link to Full Text

Share

COinS