Community-Based Organizations

CHCS senior program officer, Diana Crumley, JD, MPAff, has helped state Medicaid agencies, health plans, and community-based organizations think through issues regarding health-related social needs and social care integration over the last four years. This blog post outlines four lessons from her experience supporting health care stakeholders address health-related social needs and health inequities, while focusing on advanced primary care and Medicaid managed care.

This fact sheet outlines strategies to help Medicaid stakeholders encourage partnerships between community-based organizations and health care organizations. States can provide: (1) financial support to build and sustain program capacity; (2) assistance in identifying metrics for evaluation; (3) incentives to providers to address social determinants of health; and (4) use of policy levers, including value-based contracts, managed care organization regulations, and state plan amendments.

The Eastern Virginia Care Transitions Partnership (EVCTP) is a largescale partnership including Bay Aging and four other Area Agencies on Aging (AAAs), four health systems, three managed care organizations (MCOs), and other health care and human service providers. This case study describes several topics including the service delivery model, information sharing and reporting, shared governance, success factors, and challenges.