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.
Several years into its work fostering contracting between community-based organizations (CBOs) and healthcare entities, n4a has by now run multiple Learning Collaboratives. This article reflects some lessons learned in one of the more difficult years on record. We hear from n4a’s Learning Collaborative facilitator/co-developer Maya Op de Beke and from one of its members, the Coordinated Care Alliance (CCA), represented by Jessica Grabowski.
Lessons Learned from the n4a Perspective
Op de Beke is a program manager at n4a, having joined in 2018 after serving as a policy analyst with the Division of Aging and Disability Services in the Virginia Department of Medical Assistant Services. Specifically, she manages several projects at the Aging and Disability Business Institute, where she develops and presents content for consulting projects and grant activities, facilitates learning collaboratives and helps inform curricula, in addition to working closely with guest speakers on identifying key considerations and top takeaways from the lectures.
Coming into the 2020 Learning Collaborative Op de Beke said that as usual there were members in varied stages of developing CBO networks in pursuit of contracts with healthcare partners, from beginning to intermediate to those that could be loosely classified as advanced or operating fully as a network. “They tend to differ in infrastructure development stages,” said Op de Beke. Some are still determining their operating structure, while some have a legal structure in place—it varies across participating organizations.
“Everyone has a common goal of building up their networks, but how they go about achieving it differs,” she said.
It being 2020, challenges hit early. Many CBOs had been pivoting rapidly to deal with the pandemic’s new slate of challenges, but also healthcare entities had begun reaching out directly for help, as the pandemic clarified both the need for social services and the ability for CBOs to swivel on a dime to keep providing them. With the exception of one, members in this Collaborative ended up continuing with the course, so that although the Collaborative paused due to COVID-19 in April, it was able to resume in May and conclude in August.
‘We’re very thankful for these Collaboratives, because we need this, especially as aging network providers.’
Members remained engaged throughout the Collaborative, doing the critical homework provided, which is designed for each topic area covered. Members needed to answer questions intended to spur organizational conversations about how best to establish and accomplish goals set out for each area of operational consideration. The homework helped provide a detailed framework for how to build out a full action plan with a final product in mind. Each member, through the homework, made up an action plan for their network, which was presented to the full group at the final meeting of the Collaborative.
When it came to planning material for this specific Collaborative, the main challenge was the varied levels of operational readiness among participating networks. Op de Beke found she had to be extra purposeful in how to frame content that spoke to the CBO networks’ varying degrees of readiness. Faculty settled on a roadmap approach, versus a more professorial, this-is-how-it’s-done approach, and used many examples from the field to highlight how different networks were doing similar work.
“The overarching theme is that there’s no one-size-fits-all approach to developing CBO networks,” said Op de Beke.
Lessons Learned from One CBO’s Experience
The Coordinated Care Alliance (CCA) is a network of CBOs that partner with healthcare entities to provide whole-person care. CCA is a statewide network in Illinois and its CBOs are overwhelmingly what it calls Care Coordination Units (CCUs). CCA contracts on behalf of these CCUs with healthcare entities, insurers and hospitals to provide person-centered services at the local level. The fact that CCUs subcontract with CCA ensures consistent quality across CBOs (CCUs) and across the state, and ensures there is one central contracting point, making it easier on the contracting entities.
During the pandemic CCA lost contracts, but it was able to spend that extra time, as Grabowski said of the Network Operations Learning Collaborative, to, “look within to see how we might improve processes and bolster our foundation so that we would be better prepared to get more contracts down the road.” CCA also spent time writing down all the processes as a template to use in the future.
The Collaborative caused CCA to realize it should increase the number of CCUs it worked with and carefully analyze its current credentialing process. Previous to the Collaborative, Grabowski said, CCA didn’t have a strong enough credentialing process. CCA needed more say over which CCU was delivering the quality of care they expected, and which was not. Setting expectations on Day One, prior to a CCU joining its Network, would ensure success from the start.
Grabowski emphasized what a large role it is to be the Network Lead Entity (NLE) and how refreshing it was to be able to talk about working in this role with other members in the Collaborative. She has made good use of the Google Network Collaborative alumni groups that connects past collaborative members outside of the Collaborative, to compare notes on different policies that may affect them and how things are done in other organizations.
So much connecting has happened in the Google groups that Grabowski now considers several member participants to be her close friends. Previously she had felt as if she were a one-organization island. “But let’s learn from each other—why not?”
“We’re very thankful for these Collaboratives, because we need this, especially as aging network providers.
“We’re competing against large for-profit entities, but aging providers have been doing this work for years. This is their baby, and now with the competition, n4a is getting us to the point where we can develop great products to ensure we have a seat at the same table,” said Grabowski.