A qualitative study of CMS Accountable Health Communities providers shows a discordance in risk perception when forging a community health partnership.
Healthcare organizations and social services providers weigh the risks and benefits of engaging in a community health partnership differently, a factor that could influence how these separate entities frame partnerships into the future, according to research out of the Center for Health Systems Effectiveness at Oregon Health & Science University.
Community health partnerships have emerged as the leading strategy to address the social determinants of health, or the social risk factors that can impact an individual’s ability to achieve health and wellness. After a thorough screening from a provider, patients can be referred to a social services organization that addresses key social factors, such as food security or housing.
This system has been formalized through community health partnerships between healthcare organizations and social services providers. One primary care clinic might have a collaborative agreement with a local food bank, for example.
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But getting to these collaborative relationships isn’t always easy. The process to formalize the relationships can be long or arduous, while both organizations need to weigh whether the partnership will actually benefit them and their constituents.
“Risk perception—the belief that an undesirable outcome may occur in the future—is an important factor in whether and how organizational leaders decide to collaborate,” the researchers wrote in the latest issue of Health Affairs. “Collaborative risks may include not only the potential for new costs or liabilities but also uncertainty about others’ intentions and behaviors and the potential for reputational damage.”
Making the decision to enter into a community health partnership is also highly contextual, the researchers added. While a social services and healthcare provider may be working with the same population, each has its own bottom line that may be in contrast with each other. What may be workable for one entity and the community may not work for the second entity.
Through a series of interviews with 22 social services organizations and nine rural healthcare providers involved in the CMS Accountable Health Communities program, the researchers, led by CHSE senior project manager Shauna Petchel, determined that the decisions are often perceived differently by either stakeholder.
Overall, both healthcare providers and social services organizations reported careful consideration heading into a community health partnership. Both stakeholders said their previous experiences in community health partnerships swayed their decisions for forge a new one, but the perceived risks for a new partnership differed depending on the organization.
For example, healthcare organizations saw a lot of value in screening for social risk and using that data to build out community health programming. On the flip side, human services organizations said that data already exists and its influencing service planning.
Additionally, both organization types expressed concern about the integrity or reputation of their institutions. For healthcare organizations, this resulted in concerns about provider perceptions of a community health partnership. For social services groups, leadership feared the appearance of “chasing funding” at the expense of the organization’s stated mission.
Perhaps most importantly, both groups perceived consideration differences in funding and sustainability of community health programs. For hospitals and health systems, efforts to address the social determinants of health are a key step toward population health management and value-based care.
But it’s essentially the opposite in the social services sector. These organizations are used to operating on grants and donations. The “fee-for-service” payments they get from community health partnerships are what help sustain them, social services leaders said.
And finally, either organization had concerns about power hierarchies between the two.
“Despite a desire to learn about one another and discuss shared challenges and solutions, most health and human services leaders described struggling to make time for relationship building,” the researchers reported.
Both groups perceived larger healthcare organizations as having more power in community health partnerships, with more health entities citing difficulty making the time for cross-sector meetings. For social services organizations, challenges arise in prioritizing the many meetings it took to establish a firm partnership between themselves and healthcare organizations.
Both organizations also had a tough time identifying the best point of contact at the other’s institution and competition for workforce and credit for the program’s progress.
Some social services were apprehensive that healthcare organizations would mandate too many restrictions on accessing certain goods — dietary restrictions at the food pantry, for example — that limited client autonomy and individual choice.
These differences do not necessarily mean that cross-industry collaboration is impossible. After all, both healthcare and social services organizations cited an obligation to address the social determinants of health. However, a window into the risk analysis either stakeholder makes before engaging in a community health partnership suggests a path forward.
This includes aligning the definition of service populations and creating quality measures for social programming.
“While this research found differences in how health and human services leaders think about the risks of cross-sector collaborations, it also revealed opportunities to cultivate interprofessional understanding, build trust, and incentivize cooperation across sector lines,” the researchers concluded.
“Policy can promote cross-sector collaboration at the state and local levels through more direct support for the time and resources necessary for organizations to engage in interprofessional learning, cross-sector networking, and relationship development.”
Source: PatientEngagement HIT
