CBO Innovation in the Era of Value-Based Care

Community-based organizations like CICOA Aging & In-Home Solutions not only provide valuable resources and services for vulnerable populations, but also increasingly must become innovators as part of an integrated, multidisciplinary healthcare delivery model. So said Dr. Venus Wong and Dr. Sarah Rosenbaum, researchers at the Stanford University School of Medicine’s Clinical Excellence Research Center, during CICOA’s Envision Lecture on July 29.

CICOA’s Envision Lectures are designed to bring to the forefront issues and trends that impact health and quality of life for older adults, people with disabilities, and family caregivers.

The Stanford team first visited CICOA in 2018 while exploring value-based care partnerships that could be replicated across the country. Stanford’s Clinical Excellence Research Center is the first U.S. university center exclusively dedicated to reducing the cost of great patient care.

What began as one project is evolving into a continuing collaboration with Stanford that could have a significant impact on CICOA service delivery in the future.

Changing Healthcare Landscape

Simply put, things are changing. At the center of this change is the recognition that 80 percent of health outcomes are influenced by the non-medical social determinants of health that occur outside of clinical settings. These include factors such as where one lives, race, ethnicity, gender, income, education, housing, food insecurity, transportation, etc.

“The population CICOA serves is growing rapidly and often has disproportionate risk factors and complex health concerns. It’s already challenging to treat this population in the traditional sense, and it will absolutely be necessary in a future managed care model to optimize health outcomes of this patient population,” said Dustin Ziegler, CICOA’s vice president of community programs. “Nobody can do it alone.

“CICOA’s innovation and research partnerships prepare us for this and allow us not only to explore healthcare models, but also to show our value proposition for being part of the healthcare landscape of the future,” Ziegler said.

Value of Community-Based Organizations

As traditional long-term services and supports move into a capitated Medicaid managed care model, community-based organizations (CBOs) must demonstrate their value as healthcare delivery partners.

Dr. Wong valued the size of today’s home-based care market at $95.9 billion. In five years, this is estimated to grow into a $122 billion market.

“It’s no surprise then that CBOs are going to have more competitors,” she said. “That’s just the reality. Many startups actually are doing the business that CBOs used to do.”

But it is to the advantage of health plans to support research and innovation in community-based organizations, she argued, and many big healthcare systems are investing in home- and community-based care.

“Human service nonprofits provide critical care for around 20 percent of Americans, and the services they provide are worth more than $200 billion. This is a huge market when you look at it, and they’re advocating for a better policy and payment environment to expand home-based care,” said Dr. Wong.

“Research shows that when healthcare systems work closely with CBOs, their patients have 42 percent lower readmission rates, 20 percent lower mortality rates, and in general exhibit more healthy behaviors,” she added. “And people trust CBOs, meaning that the branding itself is very valuable.”

The challenge issued to CICOA and other CBOs is how to leverage existing resources, such as our brand and our deep connection and trust built in the community, to scale solutions to meet community need.

“We’re trying to try to break down the image of CICOA as just a social service, nonprofit entity that does nice things for people,” Ziegler said. “The services we provide—care management, transportation, meals, home accessibility modifications, caregiver support—means that we’re part of the care continuum. There’s an internal battle to pivot to that mindset, but also an external battle to get recognized by health systems as partners who help maximize patient health outcomes.”

Quantifying Quality Through Research

The team at Stanford and others are trying to quantify the quality outcomes of CBOs. Currently, that’s hard work because the industry lacks agreement around quality measures.

“When you look at hospitals, the reason health plans know which hospital they want to partner with is because they have standardized measures. This is exactly what is lacking in the CBO field,” Dr. Wong said. “That’s why high-quality CBOs are working to define quality measures. Ultimately, that will build more trust in the system and prove the business case for contracting with health partners. It’s about correlating activity to health outcomes.”

“If someone meets nursing home level of care, but because of CICOA’s intervention is able to stay at home for four additional years, that saves the state real dollars,” Ziegler noted. “You can essentially serve two people for every one with same Medicaid dollars by delivering care at home.

“Medicine of yesterday is not going to be the medicine of tomorrow. That’s why we are partnering with prestigious research institutions and innovating to gather data, establish metrics, and see how we can better demonstrate our value to healthcare entities and government alike through improved care and cost savings,” Ziegler said.

Watch the Envision Lecture