With the growing recognition of the impact of social determinants of health, health care payers and providers are increasingly engaging with social service providers. Coordinated networks of community-baed organizations led by community care hubs (CCHs) offer opportunities for health care organizations and community-based service providers to:

• Streamline contracting
• Achieve consistency in quality performance of services
• Meet compliance requirements
• Manage billing and payment operations

Evidence-based programs (EBPs), by design, require adherence to program fidelity and continuous quality improvement to achieve expected outcomes. This frequently makes EBPs an appealing service to implement as an initial contract offering for a developing CCH or part of a growing service package.

CCH role: Contract facilitation, communication, technical assistance, and oversight

Creating a culture of collaboration and commitment is an important key to CCH success. The CCH works collaboratively with all its partners to align expectations for program fidelity, consistent service quality and performance, billing and payment, reporting, marketing, and more to create a centralized administration for participating payers and service providers.

In addition to Medicare Advantage plans, commercial insurers, and health systems, there may be other funders (governmental and philanthropic) with requirements that must also be met. This too needs to be aligned to create a common understanding of expectations and compliance requirements across all participating service providers and payers.

Different states and regions do not look alike nor operate similarly. Communities may have differing needs and cultural norms. Health providers, payers, and community-based organization service providers collaborating with the CCH need to figure out and agree on services to be provided, tools used, metrics collected, etc. Much up-front work is required to achieve a successful collaborative business culture that’s a win-win for all—payors, CCH, community-based organizations, and individuals served.

Contracts: Understand roles, expectations, and requirements

Community-based organizations (CBOs) need to assess their organizational readiness to enter contracts with health payers and be ready to make adaptations to workflows, participate in new training, and more. Participating in a network led by a CCH provides a variety of benefits and supports for CBOs seeking to grow their funding and service reach referenced in the above Missouri example.

To understand why these business culture changes occur, CBOs need to understand the requirements health care systems payers and insurers must adhere to, as well as their pressing drivers.  Often these are referred to as “pain points.” Various metrics health care system payers and insurers must meet result in financial incentives or penalties. These metrics include HEDIS (Healthcare Effectiveness Data and Information Set), Medicare Advantage STAR Ratings, Joint Commission review of hospital systems, and many others. It also helps explain the expectations and requirements imposed by the contracts the CCH holds with payors. The CCH facilitating collaborative meetings, workgroups, or other methods can help forge mutual understanding leading to clearly defined roles, best practices, and standards used across all partners.

While the CCH will be the primary organization negotiating contracts, it is important for an organization and its legal team to thoroughly understand their responsibility as a service delivery partner. The CCH will be incorporating key deliverables that are part of their contract with the health care entity. A service delivery organization is obligated to perform the scope of work, meet deliverables, adhere to standards and timelines, comply with requirements, meet performance metrics, and other elements specified by the CCH as the contract holder. Below are some key features to keep in mind for contracting. Once an organization signs a contract to be part of a CCH, they are obligated to all the terms of the contract. 

Building a culture of compliance

As with evidence-based programs where providers must adhere to program fidelity; similarly, rigor, consistency, and fidelity are required for the success of the CCH and its service delivery partners." --Paul Cantrell, President, ClearView Strategies, LLC                                                     

 

The CCH works with its partners to build what is termed a “culture of compliance” to meet the requirements, standards, and performance needed when contracting with health insurers and health systems. This involves business culture change adapting to new standardized workflows for service delivery, business associate agreements (BAA), and trainings required under HIPAA, and more.  As the CCH assists in building a culture of compliance among its participating partners, so too must the partnering service delivery organizations within their own organizations.

For Missouri, Erika Saleski identified important steps implemented and tools developed to create a culture of compliance critical to the success of the CCH and its area agency on aging and CBO partners:

• Clearly define contractual and compliance standards and requirements
• Disseminate standards and requirements in approachable ways, e.g., CBO Policies and Procedures Manual
• Clearly define roles and workflows at all levels
• Create actionable Quality Assurance Plans
• Provide ongoing support and communication
• Provide training, including to meet compliance requirements such as HIPAA and data security
• IT support
• Continuous performance evaluations, monitoring, and auditing

Performance and quality measures: Measuring success

In the health care ecosystem, providers and payers need to prove performance, quality, and compliance. They are subject to performance incentives and penalties. Additionally, there are a myriad of regulatory rules carrying financial and other penalties for failure to comply. 

For evidence-based program providers and other CBOs, the CCH provides the opportunity to partner and help health care payers achieve various performance requirements.  It also means partner CBOs must meet performance standards and metrics.

It is most helpful to define success at the beginning and determine how it will be measured. Much like when applying for a grant for evidence-based programs, we need to define how we will evaluate success.  For the Mid-America Regional Council’s CCH, Medicare compliance was used as the standard to be met as it contained the highest requirements for the MA4 Network of statewide partners delivering EBPs. To achieve the metrics, the culture of compliance was implemented using various tools and training with continuous performance evaluations, audits, and monitoring. Development and implementation of quality assurance and continuous improvement plans are important tools to help meet or exceed quality and performance measures. 

Learn more about community care hubs

To assist ACL evidence-based falls prevention and chronic disease self-management grantees as well as other community-based service providers, NCOA held four webinar sessions to inform participants about coordinated networks of CBOs, now commonly known as community care hubs, or CCHs. These CCHs often start with one or more evidence-based programs as their first service offerings.

Each of the webinars focused on different core roles and responsibilities that are important when considering and participating in a CCH. Some themes cross multiple webinars such as contractual commitments for delivery capacity, quality, performance measures, IT security, and data integrity. We encourage you to listen to the webinar and view the PowerPoints to get the full benefit from the webinar series.

• Webinar #1: The Important Role of Evidence Based Program Service Delivery Providers in Community Care Hubs, Feb. 28, 2023
• Webinar #2: Quality, Fidelity, and Compliance Expectations for Service Delivery Providers, March 23, 2023
• Webinar #3: The Essentials of Data Sharing in a Coordinated Network of CBOs, April 27, 2023
• Webinar #4: Diversity, Equity, and Inclusion: Establishing Standards Across Service Delivery Providers, Leaders and Volunteers, May 23, 2023

More resources

These companion articles provide key highlights and information associated with each webinar. Other relevant information and resources are shared in the articles where appropriate.

• NCOA. The Roadmap to Community-Integrated Health Networks 
• NCOA. Five Key Steps to Building Community-Integrated Health Networks
• Paul Cantrell. How to Build a Strong Community Care Hub Lead Entity
• NCOA Partnership Assessment Tool
• Aging and Disability Business Institute. Network Readiness Assessment - Aging and Disability Business Institute
• Partnership to Align Social Care. Community Care Hubs: Making Social Care Happen
• Aging and Disability Institute and Scripps Gerontology Center. (2023, April). Lifting The Veil: How Networks Form, Operate, Struggle, and Succeed. Lifting the Veil: How Networks Form, Operate, Struggle and Succeed - Aging and Disability Business Institute
• Merideth Bratton. Aging and Disability Business Institute. Resources for Developing a Community Care Hub
• ACL Technical Assistance Community. Community Care Hub Contracting Spotlight
• Caitlin Musselman. Aging and Disability Institute, Partnership Align Social Care and Camden Coalition. Resource Guide–Partnerships with Community-based Organizations: Opportunities for Health Plans to Create Value
• Manatt, Partnership to Align Social Care, and The Scan Foundation. Working With Community Care Hubs to Address Social Drivers of Health: A Playbook for State Medicaid Agencies.

This project was supported, in part by grant number 90CSSG0048 and 90FPSG0051 from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.