In a recent Health Affairs blog post, authors Anand Parekh and Robert Schreiber describe opportunities for community-based organizations (CBOs) to contribute toward improved outcomes and reduced costs. In addition to highlighting transitional care as one way CBOs are participating in health reform, the authors also mention the following opportunities:

• Evidence-based self-management programs
• Partnering with patient-centered medical homes to receive referrals
• Collaborate with hospitals on completing their Community Health Needs Assessments, which non-profit hospitals are required to do to maintain tax-exempt status
• Partner with regional Accountable Care Organizations
• Take advantage of CMS’s State Innovation Models Initiative as an opportunity to connect with providers
• Increase business acumen in order to negotiate sustainable partnerships with payers and hospital systems (For more on this, we recommend reading the National Coalition on Care Coordination’s recent report “Building the Business Case: Community Organizations Responding to the Changing Healthcare Environment for Aging Populations”)

Another opportunity is for CBOs to play a leadership role is in Medicaid managed care initiatives that many states are undertaking. Approximately 70% of Medicaid beneficiaries across the country are enrolled in a managed care plan for Medicaid health services, and that number will continue to rise. Moreover, 18 states have managed Medicaid long-term services and supports (LTSS) initiatives for older adults and adults with physical disabilities. AARP Public Policy Institute and Truven Health Analytics recently completed “Care Coordination in Managed Long-Term Services and Supports”, a study that analyzes the status of care coordination in managed LTSS efforts in those 18 states. Some states require that managed care organizations contract with existing community-based providers to meet LTSS needs – and other states do not require that.

Illinois is one state that has moved toward managed LTSS, and the AARP/Truven report dives deep into a case study of approaches managed care organizations are taking in IL and how community-based organizations are engaging with them to best meet needs. (See numbered pages 13-19 for the Illinois case study.) While IL does not require the managed care organizations contract with CBOs, Illinois CBOs are engaging a variety of tactics to partner with them. One such approach is the Coordinated Care Alliance, which brings IL aging and disability community-based organizations together to offer a more uniform service package to managed care partners. Many of the community-based organizations who are active in partnering with managed care organizations, such as Aging Care Connections, are implementing the Bridge Model as a community-focused solution to reducing hospitalization rates and improving connections with LTSS.

Health reform has created many opportunities for partnerships between community agencies, health systems, and payers to best meet needs of community members and to curb increasing costs. How will the community-based organizations in your region respond?