Faced with fiscal instability in Medicaid, a changing policy landscape, and the shift toward outcome-based contracts, SSOs and CBOs must take steps to strengthen their professional position and prove their indispensable value to state Medicaid agency and MCO partners. The strategies outlined in this guide require more than just programmatic adjustments; they demand shifts in organizational leadership and culture. For SSO and CBO executives and board members, the path forward involves making deliberate, high-level decisions that embed value, efficiency, and partnership into the very fabric of their organizations. This is particularly urgent because the structural changes in Medicaid are likely permanent. Leaders who wait for clear signals of revenue disruption before investing in new capabilities will find themselves racing to catch up. The time to build data infrastructure, billing expertise, and partnership readiness is now, before organizations find themselves on a fiscal cliff.

Not every organization will be ready to pursue all four strategies simultaneously. Leaders should assess their organization’s current capabilities and capacity, then identify which Entry Points are most immediately achievable. As foundational capabilities mature, organizations can progressively take on Advanced Pathways to deepen their impact.

The following recommendations provide a leadership blueprint for this essential transformation.

1. Champion a Data-Driven Culture from the Top Down: The transition from reporting activities to demonstrating outcomes must be a leadership-driven priority. This goes beyond hiring a data analyst; it requires SSOs and CBOs to actively build an organizational culture in which data dictates strategy. Leaders should allocate funding not just for data collection tools, but for the staff who can translate that data into compelling value stories for payors. They should also mandate that board meetings and strategic planning sessions review outcome metrics and ROI, not just service volume. The organizational decision by LSS WI to pull back from ineffective programs and refocus resources proves that outcomes data drives the strategic investment of the most successful SSOs and CBOs.⁵⁴ By publicly tying an organization’s mission to its measurable impact, leaders signal to their teams, potential MCO partners, and state Medicaid agencies that their organizations are serious, performance-oriented enterprises.
2. Incentivize and Prepare Your Team for New Models of Service Delivery: Accepting new models and or services that support SSO/CBO service delivery like VBP, ILOS, and VAB, is as much a cultural shift as a financial one. Leadership must proactively prepare the entire organization for this transition. This means critically evaluating current staff competencies and investing in training for contract negotiation and management.

Despite the shifting policy landscape, states are still pursuing care coordination models through SPAs; for example, Oklahoma,⁵⁵ Vermont,⁵⁶ and New Jersey⁵⁷ have SPAs (approved during the current administration) that expand coverage for community health workers (CHWs) or targeted coordination. Additionally, as Medicaid waivers from the previous administration expire, states may want to continue offering care coordination and other enhanced services through a different mechanism. They will be in search of partners, like SSOs and CBOs to do so.

SSOs and CBOs should leverage their expertise in developing coordinated services that address needs like transportation, nutrition, and other psychosocial factors impacting health. SSO/CBO leaders may consider restructuring organizational compensation models to mirror the value-based outcomes bonuses their MCO partners receive, similarly tying internal bonuses to outcome achievements. This can align SSO/CBO staff’s success directly with MCO goals. Furthermore, SSO and CBO leaders could consider creating a dedicated “innovation fund” or reserve to help pilot new value-based services and help weather the cash-flow uncertainties that can come with shared-risk contracts, demonstrating a long-term commitment to this sustainable funding path.

3. Treat Operational Infrastructure as a Core Strategic Asset: In a landscape of thin margins, operational excellence is a competitive advantage. Leaders must stop viewing functions like billing, IT, and compliance as mere administrative costs and start treating them as critical strategic investments. This means approving budgets for modern IT systems that can integrate with MCO and state platforms and hiring a Chief Financial or Operating Officer with specific expertise in Medicaid managed care complexities. Such systems not only serve to strengthen the case for partnerships with managed care and state partners, but also help ensure that patients are receiving the services they need and are eligible for. Further, SSO and CBO leaders should be informed about state budgeting strategies being employed to mitigate budget volatility.⁵⁸ Understanding that states are prioritizing investments in behavioral health and maternal health, where Medicaid has an outsized role in service delivery, offers clear focus on areas for new SSO/CBO proposals for potential partners. AFS, for instance, plans to expand its coordination services to the maternal health field in cooperation with Wisconsin’s new Maternal Health Strategic Plan.⁵⁹
4. Become the Convener and Architect of Strategic Alliances: Forging alliances is not a passive activity; it requires direct and sustained involvement from leadership. A leader’s role is to be the primary convener and relationship-builder. Personally initiate conversations with peer leaders to build trust and explore collaboration. Consider dedicating specific staff time to alliance management and be willing to make strategic compromises—such as standardizing data collection or service protocols—for the greater good of the collective. These efforts may not always lead to formal partnerships like CCHs or ACOs, but can, at a minimum, provide opportunities for organizations to share best practices. LSA’s own Results Innovation Lab acts as a central convener, uniting over 50 member organizations in a collaborative learning environment that supports leaders in cultivating strong stakeholder relationships, exchanging best practices, and forming strategic alliances. By championing these partnerships, leaders can transform their organizations from a lone actor into an indispensable, scalable node in the network of service providers.
5. Embed Foresight and Agility into Strategic Planning: The policy landscape will continue to shift, and accordingly, leadership’s role is to build an organization that is resilient and responsive. Formalize a process for environmental scanning by assigning a “Policy Lead” on the leadership team, subscribing to key state and federal policy updates, and holding quarterly “Horizon Scanning” meetings to assess the current and future policy landscape. Use these insights not just for reactive adaptation, but for proactive strategic planning. Direct development teams to pivot program proposals toward emerging funding streams (like the $50 billion Rural Health Transformation Program)⁶⁰ and align organizational messaging with current administrative priorities. Use strategic alliances with other SSOs/CBOs (like CCHs, ACOs, and other backbone structures described above) to educate state policymakers about critical gaps in Medicaid and to share how SSOs/CBOs can fill them. Given the current administration, SSO and CBO leaders may consider framing their stabilization and preventive care services within the policy context of reducing overmedicalization and combating the chronic disease crisis, which is a key focus of the administration.⁶¹ Nevertheless, the policy environment described in this guide is only a snapshot. It is incumbent upon leadership to maintain awareness of the policy landscape so that, as priorities change, SSOs and CBOs can continue to offer their partnership to state Medicaid agencies and Medicaid MCOs in a way that is relevant and attractive through political and fiscal cycles.