Partnering for Impact:
How Social Service and Community-Based Organizations Can Navigate Change in the New Medicaid Landscape
THE STRATEGIC OPPORTUNITY FOR SSOs and CBOs
In this fiscally constrained and shifting policy environment, state Medicaid agencies and Medicaid MCOs need partners that can ensure maximum efficiency. Consequently, stakeholders across the healthcare industry will be seeking partnerships that:
- Improve preventive care and management of chronic disease
- Reduce drivers of high-cost diseases
- Prevent outcomes that are costly to the healthcare system and consumers
- Improve Healthcare Effectiveness Data and Information Set (HEDIS) and other quality metrics that affect payment and ratings (e.g., health outcomes and adherence)
- Strengthen cross-sector referral systems that connect individuals to community-based services and supports
SSOs and CBOs, with their deep community roots and expertise in providing services that stabilize families and individuals, are uniquely positioned to meet these demands. SSOs and CBOs also serve as critical connectors for cross-sector referral. As states and counties invest in platforms that link health care, social services, housing, and other supports, SSOs and CBOs with robust data practices and established community relationships become essential partners in making those systems function effectively. Their ability to receive, act on, and close the loop on referrals from health care partners is foundational to the kind of coordinated care MCOs are increasingly expected to deliver.
The provision of social services by SSOs and CBOs directly supports these financial and contractual goals by improving health outcomes. The strategic opportunity lies in demonstrating that SSO services are not merely beneficial, but integral to the financial sustainability of the Medicaid system and aligned with the broader healthcare policy environment. This requires SSOs and CBOs to frame their work and collect data that proves they are achieving the payors’ priorities.
This positions SSOs and CBOs not merely as vendors delivering discrete services, but as essential community infrastructure. Their sustained presence, trusted relationships, and ability to reach populations that traditional healthcare systems struggle to engage make them indispensable to any strategy aimed at managing population health and reducing system costs. MCOs and states who partner with SSOs and CBOs are not simply purchasing services; they are investing in infrastructure that extends their reach and stabilizes high-risk populations.
Core Strategies for Building and Sustaining Partnerships
This section details the critical strategies for SSOs/CBOs to navigate the fiscally constrained environment outlined above, positioning themselves as indispensable partners to state Medicaid agencies and MCOs. The four core strategies focus on proving value, adopting advanced payment models, mastering operational mechanics, and maximizing organizational scale.