The importance of cross-sector partnerships in enabling better health outcomes | Viewpoint

Health outcomes are heavily influenced by social determinants of health — the conditions in which people live, learn, work and age — such as housing, income, and employment, which are shaped by upstream structural determinants of health.

Portia Buchongo

Structural determinants of health include laws, policies, institutions, and practices that contribute to unjust social, political, and economic conditions such as systemic racism, sexism, and ableism which produce health inequities. These social determinants exist primarily outside of the healthcare system yet contribute to most of the adverse health outcomes across communities.

The national focus on the need to address health related social needs, as highlighted in the U.S Playbook to Address Social Determinants of Health and HHS Call to Action: Addressing Health-Related Social Needs in Communities Across the Nation, reinforces the continued demand for health plans, health systems and providers to reduce health inequities using strategies that address unmet social needs.

Guidance from the Centers for Medicare & Medicaid Services have positioned states to use a range of mechanisms, including “in lieu of” services and settings to increase their efforts to address social needs. However, healthcare organizations, like health plans and health systems, can't handle all these issues alone.

Likewise, community-based organizations that provide services and programs such as health education, affordable housing, legal services or other social supports, are often more familiar with the social support gaps and needs within communities. Cross-sector partnerships between healthcare organizations and community organizations can help improve community health outcomes by pooling their expertise and resources to maximize impact.

The Impact of Partnerships

By joining forces, healthcare organizations and community organizations can achieve three goals.

Connect patients with resources: Community-based organizations work to improve the lives of all citizens at a local level. They can be public or private, or not-for-profit resource hubs that provide specific services to the community such as social service agencies, religious institutions, elder-care groups, or youth development organizations. When healthcare organizations identify patients who need assistance, they can be connected to community organizations that provide safety-net services like reliable transportation, healthy food, or financial help.

Decrease healthcare costs: Under the Bridge Model of Transitional Care, social workers coordinate care with healthcare organizations for patients with complex healthcare needs and their families to ensure a smooth transition from the healthcare facility to home. This approach also connects patients to community-based supports and services and has led to readmission reduction rates of more than 20% and less reliance on hospitalizations in favor of increased follow-up with primary care providers.

Strengthen communities: Collaboration between community organizations and healthcare organizations can promote a whole-person approach that considers both the clinical presentation of patients and the role social factors may be having on their health and well-being. For example, a person diagnosed with asthma may get an inhaler from their doctor, while community-based partners evaluate how to mitigate the mold in their home contributing to the issue.

As more awareness has grown about the impact social and economic needs have on health outcomes, investing in partnerships between healthcare organizations and community organizations becomes more critical to improve quality of life and wellbeing within communities.

How community organizations can maximize cross-sector partnerships

While teamwork between community organizations and healthcare organizations is essential for delivering holistic high-quality care, these partnerships must be thoughtfully implemented. Community-based organizations should consider four core areas of focus:

Determine motivations - Each party brings its goals, expertise, and strategies to the partnership. Community organizations and healthcare organizations must align on goals, expectations, and desired outcomes. Community organizations must ensure that working with healthcare organizations will expand their network and further their mission. They also must assess capacity to identify knowledge gaps.

Cultivate equitable partnerships - Mutual trust, respect, and participation are essential. Power imbalances can impede the collaboration's stated goals. Community organizations can collaborate with healthcare organizations to establish teaming norms, design a shared governance structure that fosters trust and open dialogue, and plan a strategy for resolving disagreements respectfully. It's also essential for community organizations to feel empowered to elevate diverse perspectives, especially from those with "lived experiences."

Establish accountability - Defining parameters, whether in an informal (non-contractual) or formal (contractual) partnership sets the tone for the relationship. Community organizations may choose to be paid for their services through a range of payment structures such as a fee-for-service model or alternative payment models or may look to become part of a centralized Community Care Hub, which can provide support with financial arrangements and operations. It's also necessary to set clear and realistic expectations and address issues, including engagement timelines, shared decision-making, measurement, and data sharing.

Identify Growth Opportunities - Starting small and adopting an agile development model can support the development of trust and the relationship. Pilot programs allow community organizations to determine partner fit, test novel strategies, and evaluate the extent of resources for implementation and scaling. As the partnership progresses, it's essential to reevaluate goals, activities, and fit, then adjust accordingly. Some collaborations aren't a good match – there could be organizational challenges, goal misalignment, or other issues that hinder growth. Community organizations must be willing to discontinue the partnership if so.

How healthcare organization can maximize cross-sector partnerships

Recent changes to Medicaid policies have placed more responsibility on the shoulders of healthcare organizatoins to address health-related social needs. Healthcare organizations should consider seven core areas to create impactful cross-sector partnerships with community organizations.

Determine motivations - Healthcare organizations often partner with one or more community organizations working in a specific area of clinical expertise, such as lung cancer, or one knowledgeable on certain social services, such as food insecurity. Community health needs assessments can be a helpful resource for healthcare organizations to identify which community organizations their goals for partnership might align with. Since needs assessments are developed by state or local health departments, hospitals, and other entities, findings from these assessments can help healthcare organizations understand which social determinants are contributing to adverse health outcomes among their populations and find community organizations already addressing these issues.

Cultivate equitable partnerships - Before establishing a partnership, healthcare organizations must understand the community organizations’ mission, offerings, and how they can augment the work of healthcare workers. There must be open lines of communication and a shared governance approach. Healthcare groups should also be open to learning from community organizations, invest time in building relationships with community groups and their communities.

Understand partnership structures - Before partnering, healthcare organizations should evaluate the community organization’s size and operational and technical capabilities, and funding sources. It's also important to understand the type of partnership that is most appropriate to meet goals: direct (between a healthcare organization and one or more community organizations or a centralized Community Care Hub) or indirect (healthcare organizations can access community organizations through a community resource platform).

Establish funding structure – Healthcare organizations may look to engage in various types of agreements with community organizations partners such as a Memorandum of Understanding, sponsorship for a specific service or event, a grant, performance-based agreements or others. It’s important to develop a scope of work that considers the community organizations existing capacity to meet the goals and objectives of the partnership, areas where healthcare organizations can help ensure objectives are met, and areas that may require more flexibility amongst partners.

Collect and share data - Healthcare organizations must consider what data is most relevant to collect or provide to their community partnership and how to share it. Overcoming challenges with interoperability across entities and barriers that may arise due to HIPPA regulations requires healthcare organizations to be flexible with how they receive data from community groups. Healthcare organizations can also look to identify data that are routinely captured by community organizations that may align with their goals to reduce clerical burden.

Evaluate partnership success – Evaluating how effectively the partnership is addressing health-related social needs and meeting its intended goals with insights that may improve the partnering approach. The Centers for Disease Control or Institute for Healthcare Improvement resources provide guidance on developing an evaluation plan or incorporating PDSA cycles in partnership evaluation. It may be appropriate to incorporate metrics for the number of referrals or expansive data points into the agreement. Direct member feedback is also highly valuable and can be collected through written grievances, surveys, or at community forums.

Identify Growth Opportunities - Both healthcare organizations and community organizations should look for ways to develop and advance their partnership, particularly if there is a desire for long-term engagement. Healthcare organizations are positioned to expand their role beyond providing financial resources, and can lend technical assistance to close knowledge gaps and help community organizations expand.

Partnering for a better future of health

To meet the growing demands to address unmet social needs, the silos that have traditionally existed between health care and social care must be dismantled.

Cross-sector partnerships between healthcare organizations and community organizations are among the strategies necessary to bridge this divide. These partnerships can facilitate interventions that address inequitable healthcare outcomes for populations that have been historically underserved.

However, partnerships between healthcare organizations and community organizations must have shared goals, flexibility, and ample time invested to be sustainable and enrich the health and wellbeing of communities.

Portia Buchongo is an applied research scientist of health equity at NCQA.