Gauging Readiness for Healthcare Contracting: n4a’s New Network Readiness Assessment Tool

Editor’s note: The John A. Hartford Foundation, the Administration for Community Living (ACL) and The SCAN Foundation fund the Aging and Disability Business Institute, led by the National Association of Area Agencies on Aging (n4a). The mission of The Aging and Disability Business Institute is to build and strengthen partnerships between aging and disability community-based organizations (CBO) and the healthcare system. As partners in the Institute, ASA and n4a are collaborating on a series of articles and case studies in Generations Today that highlight community-based integrated care networks.

In recent years there has been a noticeable increase in community-based organization (CBO) network development and growth, due to parallel evolutions of the health sector and the aging- and disability-services networks. Both have become more value-based, outcomes-driven and partnership-oriented through public programs and policies, regulatory changes and other marketplace trends emphasizing and investing in population health improvement strategies. In response to the demand for standardized home- and community-based services (HCBS) delivered across larger geographies, and to a new frontier of competition in the social services space, CBO networks are becoming viable, competitive enterprises that are delivering population health solutions to health sector organizations. 

Marisa Scala-Foley, n4a’s Director of the Aging and Disability Business Institute, noted that between 2017 and 2020, n4a observed a doubling in the percentage of CBOs indicating they were contracting as part of a community-based integrated network, in data generated through the Business Institute’s periodic request-for-information surveys. This increase served as an impetus to develop more resources, including a new Network Readiness Assessment, especially as the need for such social services has only been amplified by the pandemic.

“We’re hearing anecdotal data from members of our business acumen learning collaboratives that some contracts are disappearing, some have changed, and some have paused as a result of the pandemic,” said Karol Tapias, Deputy Director of the Aging and Disability Business Institute.

“But we are also hearing the flip side,” she continued, “some CBOs have had new opportunities come up to partner in different ways than they ever would have imagined.”

Lori Peterson of Collaborative Consulting, who works closely with n4a and the Aging and Disability Business Institute and who was part of the design of the network readiness assessment tool said, “COVID-19 has underscored  the need to focus on adverse social conditions, which in turn has increased the demand for services to address these conditions. There are more opportunities to partner, not less.”

But it’s a complex process to prepare organizations to develop and grow such a network and to ensure effective contracting.

New Network Readiness Assessment

In late September n4a released the new Network Readiness Assessment for networks of CBOs working together to partner with healthcare entities. The new tool is designed to help networks of organizations gauge their readiness for building, sustaining and growing a coordinated network of service providers to contract with healthcare entities. Made up of seven modules that network members work on as a team, the modules cover leadership, market awareness and orientation, strategy and planning, financial acumen, business and network development, network management and administration.

Each module poses a series of detailed questions focused on how the CBO network and its infrastructure functions currently, and how ready it is for healthcare contracting. At the end the network is given a score, so it can assess where its strengths lie and where it might need to build capacity.

Peterson says in prototype testing one network commented that the tool served as a “reality check,” causing them to pause and focus on critical areas such as understanding the market conditions that are creating network opportunities, analyzing emerging competitors and establishing a strong governance structure and operational standards.

“Like our original readiness assessment, this network readiness assessment is meant to be an organizational conversation,” says Scala-Foley, who admits this can be messy work for networks. “There is not one person filling out the tool on behalf of an organization, but it is meant to spark discussion and debate about where the organization falls on a scale of readiness. The intent is the same for networks. This is meant to be a network conversation—to be brutally honest [with themselves] in assessing their readiness.”

“These are important conversations to have in terms of ‘how are we going to handle these situations?’ ” says Scala-Foley. “Problems will arise, whether in contract performance or in keeping members engaged. But by completing the assessment they can get a sense of where such problems may crop up and be able to anticipate situations, such as how to deal with members that are not performing well enough on contract benchmarks—and how they will handle those.”

The assessment is designed to accommodate a variety of CBO network organizing types (coalitions, alliances, independent nonprofits, association subsidiaries, independent LLCs, etc.). And it will help networks to identify and organize strategic and operational priorities, goals and objectives, as well as measure progress over time. It incorporates a new scoring system, and has an added financial acumen module, which n4a and Collaborative Consulting were seeing as an area of need even for the most sophisticated network members. 

Early Success Noted

Peterson acknowledged that at first some organizations can be resistant to using the tool as it is long and requires effort, but she said they have received lots of positive comments once it’s completed on how it stimulates dialogue, helps organizations to put together a plan and figure out where they need to improve and how to accomplish it.

Tapias says organizations can take the assessment once, see results in real time and then take it again later to note if they have improved.

“There’s also a phenomenon where folks in projects will take the assessment at the beginning of a project and then take it again and their scores will go down. Because now that they are immersed in healthcare contracting work, they have a better sense on what it takes to do the work. And they know what they didn’t know when they originally took the assessment,” said Scala-Foley.

“Yes, the more you know the more you tend to admit what you don’t know,” added Tapias.

“We will see a lot of that as a result of using the new network readiness tool ,” predicts Peterson. “Where network leaders will say, ‘Oh! Maybe we do have more work to do.’ ”

The COVID-19 pandemic has upended much work in the aging services sector, but both community-based organizations (CBOs) and healthcare systems have pivoted to adjust to new realities. “Although the Network Readiness Assessment is aimed to help organizations design and grow networks in contract with healthcare entities, there is also a viable case that networks and network strategies could be strengthened and leveraged for a variety of purposes, including political advocacy, pooling of resources for research and development efforts, distributing communications in rapid fashion and mobilizing practices, protocols and pivots in response to immediate public need as we’ve witnessed during the pandemic,” said Peterson.

Ensuring the sustainability of a network to deliver all important social services, and its success contracting with a healthcare entity is more important than ever right now. This new network assessment tool can help pave the way to that success.