Category: Education

Findhelp is a Certified B Corp and a Benefit Corporation — but what does that mean?

If you haven’t heard us say it before, findhelp is a certified B Corporation and a public benefit corporation. 

These are two designations we’re extremely proud of because they define our business and guide our work so that it benefits the customers and partners we serve, our employees, and the communities and environments where we operate.

Because the B Corp movement is still relatively new — though rapidly growing across the globe — we still meet folks who don’t quite understand what these designations mean or how they impact what we do.

In celebration of B Corp Month, we want to offer more insight into the B Corp landscape and share how this defines our efforts to help people across the country find the social services they need, with dignity and ease.

“Organizations change over time — and cultures change,” says findhelp founder and CEO Erine Gray. “We sought B Corp certification because I wanted to ensure that public benefit was built into our DNA from day one. The principles outlined by B Lab and the B Corp movement gave us the structure to ensure that the idealism we had when we started is etched into our culture for years to come.”

What is a B Corp?

The B stands for benefit, meaning the company holding a certified B Corp designation doesn’t exist just to make a profit, but to make the world a better place. 

The B Corp movement officially began in 2006, with the creation of the nonprofit B Lab, which provides third-party certification for socially responsible businesses. B Lab was founded by three friends who left the business and private equity sector with a shared goal of helping mission-driven companies protect and improve their positive impact over time.

B Lab created the B Impact Assessment, which measures a company’s social and environmental performance on a 200-point scale. Our current score is 124.6 — our highest yet — and a company must score at least 80 points to receive certification. We earned Best Overall awards from B Lab in 2018 and 2019, and Best for Customer awards from 2016 to 2019 and most recently in 2021.

To remain a certified B Corp, we undergo the B Impact Assessment every two years to review our standing among all of our stakeholders — not just owners, but employees, customers, our local community, our suppliers’ communities, and the planet.

“As a B Corporations and leaders of this emerging economy, we believe: that we must be the change we seek in the world. That all business ought to be conducted as if people and place mattered. That, through their products, practices, and profits, businesses should aspire to do no harm and benefit all. To do so requires that we act with the understanding that we are each dependent upon another and thus responsible for each other and future generations.”

 ~ The B Corp Declaration of Interdependence

In other words, companies that have been certified by B Lab have met rigorous standards of social and environmental performance, accountability, and transparency. The B Corp designation is similar to the Leadership in Energy and Environmental Design (LEED) certification for green buildings, or the HITRUST certification for privacy and security standards in the healthcare industry — another certification we hold at findhelp. 

There are currently more than 3,700 certified B Corps worldwide — like Patagonia, Ben & Jerry’s, and Seventh Generation — in 70 countries and 150 industries, from banks to energy companies to chocolate manufacturers and phone companies.

What’s a benefit corporation?

While a certified B Corp has gone through the B Impact Assessment process through B Lab, a benefit corporation has filed legal paperwork in a U.S. state or other nation to become a “benefit corporation,” a relatively new corporate governance structure based on the B Corp idea.

This new corporate status originated through the advocacy work of B Lab to help businesses acquire a legal designation that enshrines their “public benefit” status for the long haul, regardless of changes in ownership. When a business files as a benefit corporation, its public benefit is memorialized in the company’s Articles of Incorporation. The stated public benefit of findhelp is to increase accessibility of human services information to people and programs.

“When benefit corporation status became possible in Delaware, where findhelp is incorporated, we jumped at the chance,” says Gray. “A business’s charter is essentially the corporate version of our nation’s Constitution. Adding to our official starting documents our company’s public benefit and why we exist was important to us so that our mission — to connect all people in need and the programs that serve them (with dignity and ease) — is ingrained in our business at every level.”

There are increasingly more states in the U.S. and countries around the world where benefit corporation status is possible, including Louisiana, South Carolina, California, New York, Colorado, Pennsylvania, and Delaware, as well as countries like Italy, Ecuador, and Canada.

How does findhelp live up to this designation?

The efforts of our entire business are centered around widespread benefit to people across the United States. We created our search platform findhelp.org to help anyone and everyone across all U.S. ZIP Codes find free and reduced-cost social services that provide food, housing, financial assistance, legal assistance, health care, counseling, and more. 

Our B Corp status means we are also working to create benefit for all stakeholders in our company — not just customers and investors, but our community at large. Here’s a look at some of the initiatives we’re undertaking to advance our impact in the categories outlined in the B Impact Assessment:

Governance

  • We are HIPAA compliant and HITRUST certified; our users can search for local programs anonymously and they have complete control over when and how they share their personal information.
  • Our Board of Directors meets quarterly to review updates on stakeholder engagement & our social impact.
  • We prioritize helping people and treat positive social impact as a primary measure of success.

Workers

  • We provide a competitive compensation plan that includes stock options in the company.
  • We offer free employment benefits for medical, dental, vision, mental health, parental leave, and more.
  • We support employee resource groups for our diverse team’s interests and identities, and a program for team members to explore different career options within the company.

Customers

  • We monitor customer satisfaction and gather feedback from our our Customer Advisory Board.
  • We partner with customers to integrate findhelp into their organizational approach to health equity.
  • We host product feedback sessions with customer users and innovate together to expand our products.

Community

  • We provide a free and anonymous search and connection platform (findhelp.org) available at any time, in any U.S. ZIP Code.
  • We provide anonymized, aggregated data for free to qualifying academic institutions to support their social care research.
  • We support community organizations with a suite of free intake management tools (and training on how to use them) so that all the programs in our network can directly connect with people looking for help.
  • We manage a Fellowship Program that offers mentorship and funding to cohorts of community navigators.
Aunt Bertha CEO Erine Gray close up video thumbnail -Data Privacy

Watch our video on data privacy.

Aunt Bertha puts the seeker first

Watch our video on putting the Seeker first.

 

 

 

 

 

 

 

Where do we go from here?

One of the exciting aspects of working within the B Corp community is that our work is never done. B Corp status is not a one-time benchmark, but an ongoing process of accountability and transparency. It further motivates us to mark new achievements, and work toward new aspirations that increase our positive impact for customers, communities, and employees.

We recently celebrated 10 years in business, and as we look ahead to a new decade pursuing our mission, we’re interested in not only increasing our B Corp Assessment score, but doing the work to identify areas of growth so that our positive impact keeps expanding year after year.

“Many of the best performing businesses over time are those driven by a mission,” says Gray. “They put their customers first — and did things for the long run. When we first started, we knew we wanted to help people but didn’t have a well-defined business model to follow. We knew we wanted to put Seekers first, always, prioritizing the person seeking services above all, and that has guided us every step of the way.”

After a decade doing this work, we’ve connected with so many partners, customers, and organizations who are helping people every day. Our goal is to understand them and their needs as they serve their clients, patients, and members, and build the best tools possible to help them in their mission.

Our status as a B Corp and benefit corporation will continue to guide us as our platform evolves, as our partners evolve, and as the world evolves. It’s our goal to not merely grow in reaction to what we see, but to help grow the future we want to be a part of. Being part of the B Corp movement allows us to learn from other great businesses out there and do more to serve our customers, partners, employees, suppliers, and communities — today and into the future.

Want to learn more?

Read about our B Corp Certification & Public Benefit status here. If you’d like to talk to someone on our team, let us know and we’ll get you in touch.

 

An Interoperable Social Care Sector

The Road to an Interoperable Social Care Sector

The organizations that make up the social care sector in the United States – particularly community benefit organizations (CBOs) and government agencies – play a critical role in addressing social determinants of health (SDoH) by providing free and reduced cost services to individuals in need. These organizations use Systems of Record (SoR) to manage their day-to-day operations, using both analog and digital processes to perform tasks such as screening applicants for services, scheduling appointments, tracking history of interactions with clients/patients, and calculating benefits delivery. The complexity of these systems varies greatly between organizations, though most organizations need to use some SoR for reporting purposes. 

Despite our knowledge of how important addressing SDoH is to public health – and the ubiquity of SoRs – interoperability between different organizations is not the norm. This has a negative impact on our ability to coordinate and address SDoH for individuals in need, undermining progress towards public health goals and short-changing those who are most in-need of relevant services. We believe there’s a better way forward, and have developed a set of guiding principles for a more connected social care sector – improving the experience for service providers and creating better public health outcomes in the years ahead. 

The Core Principles

To enable a more interoperable social care sector, Aunt Bertha has laid out the following core principles:

These are not necessarily Earth-shattering or brand new ideals, but we don’t believe we need to reinvent the wheel to make interoperability the norm in the social care sector. Yet to-date, forced monopolies have been the dominant strategy for promoting greater interoperability. 

If 100% of the referral activity is within one system, there would be benefits. However, the innovation and financial cost tradeoffs — even if we assume universal adoption — can offset many of the benefits that come with this approach. Abiding by the core principles outlined above, we believe service providers can enjoy a better experience — particularly in the areas of referral history, outcomes tracking, and assessment histories — without abandoning their preferred SoR. 

The Path Forward

Much like how cell phone service providers have chosen to share the same towers between different carriers, we see the interoperable social care sector working in the same way. In this way, social care providers will be able to securely share and act upon information critical to improving public health in the long run.

We hosted a webinar on Thursday, October 29th — which you can watch here — to discuss how the social care sector can work toward common standards of reporting outcomes and the ways software providers can incorporate these standards into their applications. We’d like to extend a warm thank you to everyone who attended, and we’re excited to continue these conversations going forward. If you want to learn more about our technical plans as we push for greater interoperability of social care data, you can read our whitepaper next.

The CARES Act: Ensuring Due-Diligence during the COVID Crisis

Back in March, as the country began to feel the financial impact of COVID-19, Congress approved the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), a bill that allotted $2.6 trillion to help provide direct financial relief to those impacted by the pandemic. Over $150 billion of this relief was allocated for direct assistance for state, territorial and tribal governments. 

Spending

The federal government released spending guidelines which clearly articulate the spirit of the funding. The relief is intended to cover costs that are directly related to the public health emergency, for example investments in testing supplies or personal protective equipment, or for secondary impacts, such as direct economic support for those who have lost jobs or business due to the pandemic.

States are spending this money in a number of different areas, including health, small business support, education, technology & broadband, and workforce development. New York, for example, has allotted $100 million for rental assistance programs to help keep low income families in their homes. Alabama has chosen to spend $100 million on education remote learning devices to equip students with the technology they need for distanced learning. First responders in Michigan will be receiving additional hazard pay from a pool of $100 million for the work they are doing. Many states, such as Kansas, Iowa, and Maryland, have set aside CARES Act funding for small businesses. 

Procurement

In addition to defining what the funding can be spent on, the guidelines also stipulate the deadline by which funds need to be spent—by or before the end of 2020. In an effort to spend down the funds ahead of that deadline, some states are choosing to award sole source contracts rather than follow the regular procurement process. We’ve heard of several instances of states taking this path in our space, which is concerning. When multiple options are not considered and proper due-diligence not conducted, there may be a tendency to overpay and possibly miss out on better solutions, which goes against the public’s best interest and value for the state. 

In our space, there are several vendors that offer a Closed-Loop Referral System as one of their products, many of which are used to address Social Determinants of Health (SDoH). The University of California, San Francisco’s Social Interventions Research and Evaluation Network (SIREN), in conjunction with the Episcopal Health Foundation in Houston, TX, understood this challenge and developed a guide that reviewed nine of the commonly used platforms across the space, with our product being one of them. Similarly KLAS Research, a healthcare IT data and insights company providing the industry with impartial research on the software and services used by providers and payers worldwide, reviewed Aunt Bertha conducting stakeholder and end-user interviews, yielding an A rating for customer experience in relation to price, platform, and customer service. 

While we empathize with the urgency for response to assist citizens, we also believe that good stewardship of limited and precious CARES Act funding is paramount for ensuring aid gets directed to those most in need.

Rather than relying on a no-bid sole source process or the regular lengthier procurement cycle, there is a middle ground that could be used—a streamlined approach that allows for evaluation of multiple solutions in a shorter period of time. For example, taking from the private sector, could a state identify specifications by issuing a one-page requirement document, seek responses by asking potential vendors to complete a checklist, set up virtual demonstrations within days, and make a final decision shortly thereafter? By following this process, both the state and the public are doing due diligence and ensuring they are getting the best value.

Oversight

We know the federal government is particularly concerned about this issue as well, as evidenced by creation of a special committee to monitor CARES Act spending. Because the Act involves a huge amount of money that’s expected to be spent in a short amount of time (by the end of 2020), the Act included standing up the Pandemic Response Accountability Committee (PRAC) to promote transparency and provide oversight of the funds. The Acting PRAC Chair, Michael E. Horowitz, IG at the Department of Justice states on their website, “The PRAC, working closely with all Federal Inspectors General, seeks to ensure that funds intended to support individuals, workers, healthcare professionals, businesses, and others affected by the pandemic are used efficiently, effectively, and in accordance with the law.” 

Even in a time of great uncertainty and considerable stress, State Leaders are still obligated to take time to ensure that agencies are using resources that deliver services in the most efficient and effective manner possible. While COVID has, in many ways, turned our lives upside down, we believe (as citizens) leadership still must maintain its commitment to maximizing the taxpayer funds that departments receive. 

In closing, this doesn’t need to be complicated. We believe this is a more open and fair process that benefits both the government and its constituents.

Findhelp Partners with ECHO to Transform Homeless Intake

We know that housing is a critical need nationwide, now more than ever. With unemployment rising dramatically, public health at a critical risk, and stays of eviction expiring in communities across the U.S., nonprofits that support the homeless now have a substantially larger influx of those in need. 

Research has shown that addressing housing needs directly correlates to better outcomes across health, education, work, incarceration, and substance use — so the benefits of providing housing services are exponential in a community. But despite the importance of housing, it continues to be a challenge to connect people with housing services throughout recent history.

We’ve seen that housing has been the most searched service across the country, but studies show that it is simultaneously the most expensive service to provide. This not only means that housing is a limited resource, but the most difficult resource to access. 

At findhelp (formerly Aunt Bertha), this raised the question: what has been done to solve homelessness to date, and what more can we do to help make it easier to connect to necessary services? 

Partnering for Greater Impact

In Austin, TX (where findhelp is headquartered), 2,255 people experience homelessness each night, either living outside or in shelters. To serve our mission to connect all people in need to services that can help them, we started by exploring ways to help the homeless in our hometown.

Enter Ending Community Homelessness Coalition (ECHO), the lead agency that provides backbone support for Continuum of Care and Coordinated Entry systems throughout Travis County, TX, which includes the city of Austin. ECHO has the no-less ambitious mission of ending homelessness in Travis County, working closely with nonprofits and government agencies to coordinate assistance and housing for people experiencing homelessness in the community.

We partnered with ECHO to find a solution together. From June to August 2019, we collaborated with ECHO to evaluate their current systems and identify opportunities for improving their intake processes. The results were co-designed tools that improved on their existing processes, and we’re pleased to say they serve as a framework for any Continuum of Care in the country. 

To fully understand the challenges ECHO was facing and the impact this work made, it’s important to first look at what Continuums of Care are responsible for accomplishing, and how they came to be.

The Origins of Continuums of Care

In the wake of the subprime mortgage crisis between 2007 and 2010, the government established a network of nonprofits devoted to addressing homelessness nationwide. The goal of this network was to coordinate housing placement across the thousands of programs that receive United States Department of Housing and Urban Development (HUD) funding. This includes the vast majority of all homelessness housing programs in the country.

These organizations, called Continuums of Care, provide oversight in every city, county, and region in the country. Continuums of Care can be as small as a city or as large as a state, depending on the density of homelessness. All homelessness agencies collaborate with their Continuum to establish shared guidelines for how to serve every person experiencing homelessness in their area, based on their community’s needs.

A key part of a Continuum’s job is establishing a uniform system entry assessment to: 

This standardized intake assessment, called Coordinated Entry, is then shared by all homelessness agencies in an area so that each can quickly, effectively, and consistently match people experiencing homelessness with the services that can best fit their needs, even if that service is at a different agency. With Coordinated Entry, each agency can move beyond the first-come-first-serve model and instead  prioritize clients with the most urgent needs, who are the best fit for their specific service.

Co-Designing to Transform Coordinated Entry

To serve ECHO, and to connect people to housing services, we first needed to understand the gaps in their existing technology, difficulties in their daily work, and places where findhelp could help them serve people more effectively. We set up a series of walk-throughs with the ECHO team to understand their current processes and technology. Here’s what we learned:

Key Opportunities to Enhance Pre-Screening

By walking through these processes with ECHO, we were able to identify three key opportunities to enhance their pre-screening process:  

  1. Enable ECHO assessors to spend more time working with the people they could help, and less time referring those not eligible for coordinated intake to other housing resources. 
  2. Give clients a better experience by providing instant feedback on whether they were eligible for coordinated assessment, or immediately connecting them to other resources in the community if they weren’t eligible.
  3. Provide better tools and reporting to help staff collaborate,  streamline workflows, share caseloads, and manage their overall program resources.

Based on these takeaways, we then built a prescreening tool that could complement their existing systems.

Introducing Our New Coordinated Entry Pre-Screening Tool

Our goal was to ensure that clients can still walk in, but for those who are online, our new prescreening tool had to automatically determine if that person is literally homeless before they interact with an assessor.  

The result is our new pre-screening form, in which clients provide basic information such as contact info, identify what kind of services they need, answer a series of questions on their unique situation to determine if they are literally homeless, and provide blocks of time that they’re available for an appointment.

Behind the scenes, ECHO’s assessors get instant insight into which clients are facing literal homelessness. The entire team has a shared view into how far each client is in the process of getting assessed. They have a suite of reporting that provides a top-down view of all their program’s work, as well as a workflow dashboard that sorts clients according to the next steps for their assessor.  

The analytics we’ve built for this prescreening tool provide ECHO with better ways to split the workload between several assessors, as well as crucial information that can help them manage their resources or apply for additional grant funding. 

For ECHO, this prescreening tool provides a much better experience for both clients and staff alike. For people who aren’t eligible, our form provides that feedback instantly, along with links to alternate resources in the community. For clients who simply need to update their contact information, the experience is fast and painless. Case managers can easily refer their clients through this form, allowing for better collaboration between the many organizations who are working with homeless individuals throughout Austin. 

Looking Forward: Supporting More Continuums of Care

We’ve continued to work with ECHO to fine-tune this suite of Coordinated Entry tools. For example, we’ve recently added workload reports so that program administrators can see how many in progress pre-screens each assessor has in their queue. 

We’re excited to continue rolling out this new prescreening tool to other Continuums of Care across the country. Our goal is to continue to learn more places where findhelp can serve our nation’s helpers. We’re now working with Continuums across several different coordinated models, who use other assessments such as the Vulnerability Assessment Tool (VAT), and with other agencies that offer services under Continuums of Care.

Next Steps for Continuums of Care

If you’re working within a Continuum of Care, here are a few resources we think would be helpful to you:

 

Findhelp and United Way Austin Team Up to Launch ConnectATX.org

For 20 years, United Way for Greater Austin has managed and operated the 211 call center for the Central Texas region, connecting callers with people who can help them find resources, such as food, housing, or transportation assistance. 211 is a nationwide service, but localities manage their own centers, often using contractors like United Way ATX, each according to guidance from individual states.

In August of 2019, United Way ATX, with support from the Michael & Susan Dell Foundation, partnered with findhelp to build an online component that mirrors and enhances 211, connecting more Central Texans with resources that improve health and wellness. 

For the past decade, findhelp has worked with a wide variety of organizations — from health plans to school districts to county governments — to create customized sites that connect to findhelp’s vast directory of program listings.

Connecting Central Texans to Resources

The new site, ConnectATX.org, launched just last month, two weeks before the COVID-19 crisis kicked off an economic freeze that heightened public need for basic necessities like food and housing. As people began losing jobs and schools closed, call volumes at 211 soared. But ConnectATX.org was already running and able to carry some of the load.

“The website and the call line complement each other,” says Gyllian Garvey, director of ConnectATX for United Way ATX. “211 is for those individuals who may not have access to the internet or don’t really know how to use a computer. And then ConnectATX is there for those who may not feel comfortable having a conversation over the phone about the struggles they’re having. But they’re in a place where they’re ready to research and start helping themselves.”

The ConnectATX.org site welcomes visitors with the line “Help Starts Here,” then offers categories of assistance, including food, housing and utilities, transportation, job training and education, health, mental health, parenting and family, and child care and enrichment, with subcategories for each. The site uses icons and minimal text to make it more accessible to people at various reading levels.

Visitors to the site can search for and find programs in the Central Texas region to serve their needs, with options to save programs, share them, or contact programs directly. The site also allows United Way ATX staff, ConnectATX visitors, and nonprofit helpers to track the status of individual requests.

“That’s the piece that really differentiates ConnectATX from 211,” says Garvey. “Right now, we connect callers, and we do some follow up calls, but, for the most part, we just don’t know if they get help or not. With ConnectATX and with findhelp, [we can] visually see whether or not the person got help, where they got help, and if they couldn’t get help initially, were they connected with someone who could actually help them?”

United Way ATX is currently working with service providers and nonprofits in the region to further strengthen the network, allowing more people and helpers to guide the community toward resources. More helpers equals more connections equals a healthier community overall.

The Impact of COVID-19

Once the COVID-19 crisis hit Central Texas, a new feature was added to the ConnectATX site to highlight emergency food assistance, which is currently the top need nationwide. The City of Austin, as part of its wide-ranging effort to combat the crisis, designated ConnectATX as the go-to site in the region for resources related to food assistance. 

Now, findhelp and United Way ATX are working together to keep the ever-changing list of food programs updated for a growing number of visitors. In the weeks following the city’s shelter-in-place order, United Way ATX has seen a 400 percent increase in usage compared to the first week of “pre-COVID” activity.

Amy Price, director of the 211 navigation center at United Way for Greater Austin. Photo by Kelly West / findhelp

“I’ve been amazed by the findhelp teams,” says Amy Price, navigation center director for United Way ATX. “They’ve pivoted quickly to provide very creative and innovative solutions. It’s been astonishing. Everyone’s been amazed that we’ve been able to get ConnectATX.org transformed in such a short amount of time.”

Bianca Peterson, findhelp’s customer success manager for United Way ATX, sees the partnership as “a huge asset to the community,” partly due to the connections United Way has built over time with community-based organizations in Central Texas.

“We’re excited and proud to serve Austin and Travis County in this way,” Peterson says. “Going forward, our role at findhelp is to focus on optimization. Do staff feel comfortable using the site? Does everybody understand the most efficient workflow and how each of the tools work? Do we need to retrain? Now, with the site launched, we’re interested in maximizing the power of the platform to serve as many people as possible.” 

Going Deeper with Service Navigation & Assessment

Because 211 is already an established call center designed to help the community, United Way ATX was able to add another layer to their service as part of the ConnectATX project.

People who call 211 seeking help of one kind might be forwarded to a ConnectATX call specialist, who asks a few questions to assess whether services in other categories might be beneficial. This same questionnaire is also available online and generates a tailored a list of programs once it’s completed.

“Our call specialists, even in the first week, said this was something they really loved about ConnectATX, getting to hear more of the stories from individuals,” says Garvey. “They got to spend more time on the phone with them and address more than one concern in one sitting, which they couldn’t do on the 211 side. They found that to be really impactful. They knew they were actually helping the caller on the other side because they were giving them more resources than in just one subject matter.”

This higher level of service — with call specialists shepherding the process — is temporarily on hold, so United Way ATX can commit its full team to the surge of 211 calls related to the COVID-19 crisis. But the online questionnaire is still available, and Garvey says people continue to find it, fill it out themselves, and receive a list of programs to suit their profile. But the effects of this tool could have far-reaching effects over time.

“The goal for ConnectATX down the road is really to create these longitudinal records of individuals. Somebody who might need help finding food might also need help getting transportation to their medical appointments and may also need help finding childcare for their kiddos,” says Garvey. “I would love to reduce the number of times these individuals have to answer the same questions and fill out multiple forms, and instead have one centralized platform where we can track and help people across the city in the healthcare space, in the social services space, the childcare space. I think that would be incredible.”

The CARES Act: Putting Money in People’s Pockets

Last week, the federal government passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This legislation is the third in a series of bills in response to the worsening COVID-19 pandemic. The first two bills taken together focused on critical prevention and treatment, free COVID-19 testing, and temporary paid sick and family leave policies for a swath of the American workforce through the end of 2020. Essentially, these first two bills aimed to shore-up the country’s critical public health infrastructure and enable workers infected with COVID-19 to stay home so as to prevent further spread of the virus. The third bill is aimed at stimulating the American economy, which has been devastated by the effects of the pandemic. This blog breaks down how two of the most important features of the bill, direct cash payments and enhanced unemployment insurance, will impact Americans struggling during the COVID-19 pandemic. 

Income Replacement

As I highlighted in my last post, supporting Americans with cash is critical during these uncertain times because people are struggling to pay for a variety of basic necessities, and cash provides the flexibility for people to prioritize their own needs. Furthermore, as people use this cash to pay for groceries, rent, take-out, etc. they are also stimulating their local economy by providing revenue for local businesses. The CARES Act includes multiple benefits intended to put cash directly into the pockets of Americans. Specifically, the federal government will send a one-time payment of $1,200 to adults who make under $75,000 a year and an additional $500 per child– although most high school seniors and college students won’t get any money. Adults who make between $75,000 and $100,000 will receive a reduced payment depending on other qualifying factors. The Washington Post developed an easy-to-use payment calculator that takes the various factors into consideration so that anyone can estimate their one-time payment. 

Aside from providing cash to large swaths of Americans, the CARES Act also enhances existing unemployment insurance benefits. Over 3.2 million people filed for unemployment insurance between March 15th and March 21st, which is the highest surge in unemployment claims ever recorded in one week. To put this number into perspective, the previous record for most unemployment claims in a single week was in 1982, when there were  695,000 claims submitted. Just to show how unprecedented this number of unemployment claims is, the graph below shows unemployment claims per week since 1967.

Source: U.S. Employment and Training Administration/Vox

The most recent week of jobless claims dwarfs anything that’s been recorded. The staggering number of unemployment claims is just one piece of a rapidly declining economic picture for millions of Americans, and it begins to convey why there is bipartisan support for such a large-scale stimulus. 

For the millions of Americans who are losing their jobs, the CARES Act extends unemployment benefits by 13 weeks and adds an additional $600 a week for up to 4 months. Typically, states are concerned about raising unemployment insurance for fear of disincentivizing work. The thinking goes that if the benefit is too high, laid off employees will delay reentering the workforce. However, during a pandemic unemployed workers are not expected to immediately reenter the workforce because the economy is hemorrhaging jobs and typical job seeking behavior is no longer safe. 

While everyone who obtains unemployment will gain these enhanced benefits, the amount an unemployed worker will receive will depend on which state they live in. The Department of Labor oversees the unemployment insurance system, but each state runs their own program which typically consists of up to 26 weeks of payments at about half of their previous wage. Each state provides a unique benefit cap ranging from $213 a week in Mississippi to $546 a week in Massachusetts. 

Sustained Support?

These payments will be incredibly important for millions of struggling families, but the question then becomes – will  this be enough? This pandemic is not going to disappear overnight, and families will be feeling the economic ramifications for months or even years. As the true scope and breadth of the financial disaster becomes more clear, lawmakers are going to have to come to grips with the need to make more sustained investments in the economy, likely putting more money in the hands of struggling Americans. Even before the CARES act was passed, leaders in congress were already discussing a fourth bill that would include future cash payments. But the legislative response has been a constantly evolving effort and bi-partisan support cannot be counted on as we begin to approach the election. It is encouraging to see the federal government make these initial investments, but hopefully we see a sustained commitment from policy makers that matches the seriousness of the crisis.

A Look at the Federal Response to COVID-19

The COVID-19 pandemic provides a unique challenge for governments. Not only is it a public health crisis of historic proportions, but also the subsequent economic recession will necessitate genuinely massive investments across the economy. It’s too early to tell what the ultimate impact will be in terms of lives lost and livelihoods ruined, but the effects of this pandemic will be with us for years to come. 

Free Testing, Vaccine Research, and Paid Sick and Family Leave

In response, the federal government has passed two major bills to combat the COVID-19 pandemic, with a third bill currently being developed. The first bill included $8.3 billion focused on critical prevention and treatment, like vaccine research and state and local public health department efforts. These measures injected the sprawling U.S. public health apparatus with enough funding to get some of the most urgent actions underway.

The first bill included $8.3 billion focused on critical prevention and treatment. 

The second bill, called the Families First Coronavirus Response Act (FFCRA) mandates free Coronavirus testing, allocated over a billion dollars across an array of food programs, and created temporary paid sick and family leave policies for a swath of the American workforce through the end of 2020. Notably, the version which was signed into law provides exemptions for healthcare providers, employers with more than 500 employees and employers with less than 50 employees. About 89% of employees at these large companies already have some form of paid sick leave, but that still leaves roughly 6.7 million employees at large companies without paid sick leave. For the millions of workers that work for companies with less than 50 people and healthcare and emergency responders, their employer can apply to have the leave requirement waived. In an effort to remove the burden from employers in providing this benefit, the federal government is funding these paid and family leave policies through a refundable employer payroll tax deduction. Meaning 100% of the costs will be reimbursed by the federal government. 

That leaves roughly 6.7 million employees at large companies without paid sick leave.

The FFCRA  expands the social safety net for employees who get sick from COVID-19 in the hopes that sick workers will stay home to reduce the spread of the virus. This is the most important thing public health experts and economists both stress: reducing exposure and infection is the most critical thing American’s can do right now. The economy can only begin to recover when the pandemic is under control, and the only way to do that is to slow the spread of the disease. This is why a part of the government’s response is to incentivize sick people to stay home so that they do not infect more people. Unfortunately, many American workers can’t afford to not work when they’re sick. Prior to the passage of FFCRA, over 36 million workers in the U.S. lacked any sort of paid sick leave. Considering about 40% of adults can’t cover a $400 emergency expense with cash, savings, or a credit card bill that they could easily manage, many workers have to work while they are sick just to cover basic necessities like rent and food. Providing an income replacement for workers sick with COVID-19 not only keeps them from spreading the disease to more people, but allows them to recover knowing that they won’t lose their ability to pay for basic necessities. 

Economic Stimulus: Cash Rules

In terms of spending, the third piece of legislation is expected to dwarf the first two. Officials have discussed an economic stimulus package anywhere in the range of $750 billion to $1 trillion to provide direct cash to Americans and loans to businesses. 

Officials have discussed an economic stimulus package anywhere in the range of $750 billion to $1 trillion.

The discussions around this third bill highlight how critical basic income replacement will be during this time. A poll conducted at the end of last week found that 18% of households had someone who is already experiencing reduced hours or has been fired due to COVID-19. That number will likely increase in the coming weeks, which could lead to serious economic instability for a large segment of the population. Providing the flexibility of cash is going to be important during this time of uncertainty so Americans can best prepare themselves and their families for what may be a prolonged battle against the COVID-19 pandemic. 

18% of households had someone experiencing lost wages due to COVID-19.

 

Looking Forward

All three of these initiatives add up to a massive investment in the COVID-19 pandemic response and recovery. However, there are still a number of lingering questions. We simply do not know when it will be safe to return to our normal lives. Until that happens, whole segments of the economy will be running on fumes. Now that the government is considering sending checks directly to Americans, will this be a one-time dispersal or will it continue as long as we are told to remain in “social isolation”? Whether it’s a check for $1,000 or more, a one-time payment will only help so much if previously employed workers are unable to earn a living. If this continues, considering how difficult it is to reenter the workforce, how will the federal government incentivize struggling businesses to keep employees on the payroll? For now, it is hard to believe any investment is too much. Let’s hope the federal government is up to the task of making big, bold investments now to blunt the worst of the impact.

To learn more about how Aunt Bertha is responding, click here to read our recent blog post.

Ivy Tech Community College Helps Students Address Life Challenges

Samantha Owen quit her job to finish college, and her husband works full time on the night shift, so they switch off caring for their two toddlers. “My kids know I go to school, and they know that when mommy’s not here, that’s where she is, you know? And I want them to see how important it is for them to have an education and stability before they make a family,” Owen said. All photos by Kelly West / indhelp

Working toward a degree can be an exciting time in a student’s life. It is a solid step toward a rewarding future and a dream fulfilled. However, for some students, it can also be a stressful time with outside factors such as food insecurity, medical or mental health issues, or the threat of homelessness making it tough to focus on learning.

At Ivy Tech Community College, a network of more than 40 campuses in Indiana, a pillar of their strategic plan is to ensure the basic needs of students are met.

Ivy Tech’s graduation rate for students starting school for the first time in Fall 2015 was 21.5 percent, on par with national numbers for community colleges. That rate included students who took up to three years to graduate, or 150 percent of the time it would normally take on a two-year.

“We are aware of the many challenges that our students face, not just academic. Food insecurity, housing insecurity, health challenges, child-care issues, transportation. All of these can distract students from academic success. We knew we needed a solution, and we also knew it needed to be on a large scale.”

– Jodie Beatty, Vice Chancellor for Student Success at the Sellersburg campus

For Ivy Tech, that solution was Findhelp.

Ivy Tech Community College of Indiana offers a variety of wraparound services, designed to help students dealing with everything in their lives outside of academics. The college decided to partner with Findhelp to give their students better access to social services in their area.

Findhelp started in 2010 and is a web-based platform that makes it easier for anyone to find the social services they need. Instead of having to click through a multitude of tabs from government and other sites to find an organization that might be able to help their situation, users simply type in their ZIP Code. The service, based in Austin, Texas, is free for all searchers and can be used 24 hours a day, eliminating the need to wait in lines or fit requests for help into set business hours.

With so many challenges facing Ivy Tech’s student body of almost 80,000, Beatty says they did their research and settled on a partnership with Findhelp.

“A single unfortunate life event can quickly derail someone from their education. Food and housing insecurity, unreliable transportation, and ever-climbing living expenses are all real scenarios that modern students face that can lead to increased dropout rates and long-term life impact. Ivy Tech Community College partnered with Findhelp to create Ivy Assist to help ensure students’ basic needs are met so they don’t have to choose between tuition or dinner.”

– Christen Geiger, Senior Customer Success Manager for Findhelp

“We landed on Findhelp because it is so easy to use and can be done on a large scale. And students didn’t necessarily need help to use it, Beatty says. The project was initially tested at three campuses  –  Sellersburg, Columbus and Lafayette  –  in March 2019 and to all Ivy Tech campuses in June 2019. “This fall is our first big semester,” Beatty says.

DeShawn Burrell, director of The Student Resource Center at Ivy Tech’s Sellersburg campus, conducts regular presentations for students about campus and community services that are available.

“Now, Ivy Assist is an extension of our office,” Burrell says.

Burrell says students who come directly to her office for help with food, housing, and other issues are pointed to the service. “We have very little time to discuss the intricacies of the program. Students like having that option to look through programs themselves. If I am unavailable or they need help during off hours, I advise them to go online and search Ivy Assist,” she says.

This flexibility has been eye-opening for Ivy Tech staff.

“I don’t know that anybody else had that ability to give us that level of information and that level of support to our students,” says Kat Stremiecki, Executive Director Student Life.

From Ivy Assist (powered by Findhelp)’s launch date of March 18, 2019, through the end of October 2019, a total of 12,316 distinct users had logged in, with a combined 26,561 searches. In October, an average of 83 users logged in each day.

Ivy Tech Community College of Indiana offers a variety of wraparound services, designed to help students dealing with everything in their lives outside of academics. The college decided to partner with Findhelp to give their students better access to social services in their area.

According to the Association of American Colleges and Universities, 50% of all community college students face food insecurity and 25% had experienced very low food security, which generally means they have access to some food but still qualify as hungry. And of the community college students who fall into these categories, about 75% also say they had housing insecurity, up to and including intermittent homelessness.

Ivy Assist’s most common search terms since the launch of the site are “food pantry,” “help pay for gas,” and “help pay for internet or phone” with the top three search categories being “housing,” “food,” and “health.”

College student Natasha Dennison picks out food items from the Bear Necessities food pantry at Ivy Tech Community College of Indiana in Indianapolis. Ivy Tech offers the food pantry on campus as part of the college’s wraparound services, which seeks to address students’ non academic needs.

Many community college students juggle busy everyday lives in addition to their studies. Samantha Owen is a perfect example.

Owen’s typical day goes something like this: “My husband and I wake up and get our two kids ready for their day. My husband, who works overnights as a manager at a local factory, takes our oldest child to school and then comes home to take care of our youngest while I go to class at my campus, about an hour away in Sellersburg. After class, I often come home, change and go to work. I get home just in time to take over child care so my husband can leave for his shift. And then we do it all over again.” Owen also cares for her mother, who has multiple sclerosis and chronic obstructive pulmonary disease, and often visits and cares for her grandmother, who was recently diagnosed with dementia.

While trying to balance home, work, and school, Owen found herself needing help paying for tuition and supplies. She sought out Burrell and learned about Ivy Assist.

“Ivy Assist is so simple to navigate, and I had no idea about the thousands of resources all within my reach. I will graduate in fall 2020 with an associate’s degree in Respiratory Therapy. I cannot ever find the words for how grateful I am that I get to finish this degree with so many people that believe in me.”

– Samantha Owen, Ivy Tech student

Owen is so impressed with the range of offerings and ease of use with Ivy Tech that she says she recommends the service to friends and classmates who are needing a little help.

“My best advice would be to not be so prideful,” she said. “That sometimes you have to reach out and let others know what you’re going through.”

Ivy Assist helps students find even the most basic items that most college students – and the rest of us – often take for granted.

Destiny Clark volunteers as a coach for the Brandeis Elementary Bears cheerleading team every week, in between working, going to college, and raising her 4-year-old son, Tevin. “I’m going to school and I’m being a mom and I’m giving back to our community, I’m giving my time to my community and I’m working as much as I can. And so I feel like it should be a little bit easier for me,” Clark said.

Destiny Clark, who will graduate in 2020 and go on to pursue a medical degree, didn’t know where to turn when she needed to wash clothes.

“We didn’t have any washing powder, and I was broke,” said Clark, a single mom to a 4-year-old son. “I was only working weekends because I am in school full time. I don’t really have time to go to work all the time and raise him and pay for childcare and stuff. So, I was desperate. I needed something to wash out clothes. Sometimes it’s like the smallest things that can trigger you, you know?”

A friend pushed her to speak to Burrell, who helped Clark find what she needed through Ivy Assist.

Currently, about 25 percent of students who visit Burrell have heard of Ivy Assist, she said. And word-of-mouth is spreading.

Burrell gives regular presentations about the service and after each one, she hands out bookmarks or marketing materials with more information on Ivy Assist. “I follow up with emails to see if they found Ivy Assist helpful or if I should follow up with them later,” she says.

So far, Burrell sees the type of requests she most expects, such as housing and childcare.

“They may have been in dependent relationships and are trying to get out on their own or came from another situation. They just don’t have housing security,” she says. “Also, we get many requests with utilities; I am sure we will be getting more of those with it getting cold.”

Samantha Owen serves lunch to her mother, Amanda Stancil, who she visits every day at her home in Madison, Indiana. Part of Owen’s motivation for going back to college to study respiratory therapy came from her experience helping care for Stancil, who has MS and COPD.

“Our students are here in the first place because a lot of them are trying to break out of that cycle of poverty, and they know that education is the way to get out,” Stremiecki says. “If we as an institution can help them get through that time by having a food pantry on campus or providing free bus service or having mental health counselors or even just emergency funds available for when students come up short at the end of the month and before they get paid the next time, we’re excited to be able to do that for our students.”

Kirin King, a 2017 Ivy Tech graduate who has returned to do an internship as she pursues her bachelor’s degree, uses the platform to help current students every day.

King’s internship is through disability support services, specifically an area called Pod 7, a wraparound service that helps students connect with services that can be found through Ivy Assist.

“I introduce Ivy Assist to every student who comes in. I have them go online, pull up Ivy Assist and pull down the list of local food pantries and make their own folder they could save so they can use those pantries if they aren’t at school and really need food,” she says. “Someone came in and needed a place to live, so we looked up housing options. Another student’s father has dementia and she won’t be able to care for him much longer, so we looked up care options and facilities for the elderly.”

King’s experience navigating Ivy Assist with students helped her when she fell on hard times herself. “My husband recently lost his job and I was looking for options for food, bill pay, job options just for ourselves.

“The folders have been a really big star point. It’s a good bonus because it keeps things on track, so a lot of the students really like the folders,” she says. “So far, I have used Ivy Assist with almost every student who comes in.”

One of Ivy Assist’s most useful features for help students is the ability to add services as new needs arise. “I have seen an increase in students asking for legal aid, so I was able to add that to the app,” she says.

Other campuses using the service report growing success as well. Kassie Ziegler is working toward her associate’s degree in general studies at the Columbus campus while also interning in human resources as a liaison between the community and students.

“At Ivy Tech, faculty and students have close relationships. I remember that on my first day, I had four faculty members stop me and ask if I needed anything,” Ziegler says. Students who need assistance generally reach out to an instructor or adviser, she says, and as new resources are discovered, the Ivy Tech faculty and advisers can update the Ivy Assist list and email students who have reached out to them for a specific kind of help. “Faculty members will come to us and let us know a student got the help they needed. Ivy Assist is a very good program.”

Samantha Owen is attending college full time at Ivy Tech Community College of Indiana – Sellersburg in order to complete her respiratory therapy degree. Owen is also a mother of two toddlers, and found herself struggling to pay her tuition and textbook fees once she stopped working full time to go to school.

Owen says Ivy Assist was there for her when she really needed it. “At the time that I needed the assistance, it was paycheck to paycheck. And then all of a sudden, I had this huge bill for school, not including supplies, uniforms, background testing, shot records. And it kind of just hit me like a train.

“I didn’t know what to do it and know who to go to. But finally, I got my answers. I think once I got over the hump of telling people that I need help, it became a lot easier to explain to them what was going on,” Owen says.

She says that in her view, Ivy Assist is the best choice for students in need. “Ivy Assist is better than just searching it on Google because it’s specific to your area. You can search on there and … pull up something close to you, something tangible within your reach that you can go to or people you can talk to.”

Part 4: A Blog Series on the Highly Anticipated CHRONIC Care Act

The Rising Prominence of Community Based Organizations

By Bella Kirchner, Special Projects Manager

As healthcare reimbursement models evolve to pay based on value (high quality care at lower costs) rather than on volume, healthcare plans and providers are focusing on the factors outside of healthcare that can impact a patient’s health.

Studies show that addressing these factors can lead to better health outcomes, which in turn, lower the cost of care. For many decades, the healthcare industry has focused on using clinical medical care (e.g., office visits, medications, hospitalizations) to improve the health of their patients. However, research shows that much of a person’s health is actually not determined by clinical healthcare, but by a person’s individual behaviors and social & environmental factors, often coined “social determinants of health.” When you don’t take care of a patient’s basic needs, their overall health suffers.

The realization that these factors have a major impact on both health outcomes and the cost of care has led to changes in both care and reimbursement models. While all of these changes are pushing health plans and providers to focus on social determinants, they are quite aware that they’re in the business of health, not social care, and know that working towards more formal partnerships with Community Based Organizations (CBOs) is going to be critical to successfully providing social care.

The Role of CMS

The Centers for Medicare and Medicaid Services (CMS) has also bought into the importance of addressing social determinants and is pushing the industry in that direction in the form of a new way to payment model that was introduced last year. The new payment model will be implemented in 2020 and specifically impact Medicare Advantage (MA) plans. MA plans are private health insurance plans that those eligible for Medicare can purchase. These plans provide Medicare beneficiaries additional benefits beyond traditional Medicare, such as dental and vision coverage and, starting in 2020, social care benefits as well. The reason why this is so significant is because of the huge and growing number of Medicare Advantage beneficiaries. While Medicare Advantage already had over 20 million enrolled members in 2018, there appears to be a strong growth trend that indicates this number could grow much higher. Between 2017 and 2018 alone, 1.5 million new members signed up, a growth of eight percent from the previous year.

When CMS starts to pay for social care, there is suddenly a much larger pool of people whose health plans have a specific interest in ensuring their members get these services—and those health plans are likely going to turn to CBOs to help provide those services. This is a great opportunity for health plans and CBOs to work together to improve the health and social care landscape.

Working Together

The idea of healthcare organizations and CBOs working together is not a new one. In a study from December 2017, Scripps Gerontology Center surveyed almost 600 CBOs and found that just over a third of them already had contractual relationships with healthcare entities, with the two most common entity types being Medicaid managed care organizations (MCOs) at 35% and hospitals/hospital systems at 28%.

However, this was before the new CMS social care reimbursement model for Medicare Advantage plans was released. With the new social care payment model being rolled out in 2020, there is an entirely new and very large group of people (over 20 million) whose health plans have specific financial incentives to connect them to certain social care services. CMS, in line with its new payment model incentivizing social care, is also encouraging tighter integration between health plans and CBOs. CMS recognizes that these services aren’t normally provided by health plans and so, as outlined in their recent announcement, is pushing Medicare Advantage plans and CBOs to become more closely connected by encouraging the following:

No Longer an Afterthought

CBOs, rather than an afterthought, suddenly become major players in this new reimbursement model. Because reimbursement models are driven by better health outcomes (which are tied to getting better social care) and because CMS will be paying for certain types of supplemental social care benefits, plans become more inclined to ensure their patients are screened and receive these services.

Of course, this transition will not happen overnight. Because this move for health plans to arrange social care is so new and complex, it’s likely that they won’t dive into the deep end right away, but will instead start by dipping their toes in the water. They will likely lean on existing partnerships and will establish new ones gradually. The perspective of the CBOs cannot be lost in this transition as well. There are larger questions around what role CBOs want to play in this healthcare game and about who is going to do the work.

Who Does the Work?

As CMS, health insurers, and healthcare providers begin to navigate this new territory of having to refer to and help arrange social care, many questions start to arise around who does the work.

Who will be responsible for…

No one industry or organization can do it all. The siloed models of the past will not work and so an entire network of players is going to have to come together.

While in theory this reimagining of the health and social scare landscapes sounds great, there are concerns about how to make this work on the ground. The Blue Cross Blue Shield Foundation of Massachusetts recently published a report on how CBOs are responding to the healthcare market moving into the social care space in Massachusetts. For so long, we’ve heard about this new focus on social determinants from a healthcare perspective so this study is a welcome opportunity to hear from CBOs about the industry transition.

In the study, CBOs definitely recognize the benefits of being more closely connected to healthcare organizations—more financial incentives, financial risk moving to health care organizations (spurring more interest in care coordination), better access to financial and political resources, better policy. However, CBOs also have a number of concerns, including the potential of quickly running out of capacity due to new higher-volume sources of referrals (health plans and healthcare organizations), the focus away from their original missions in their attempt to partner with healthcare organizations, the inability to have strong negotiating powers at the table with large, well-funded healthcare organizations, and the larger impact on the entire social care system.

Looking Forward

In order to efficiently and effectively coordinate, offer, and provide the social care so many people desperately need, healthcare entities and CBOs are going to need to come together and have conversations about how to make this work on the ground. Financial incentives are finally aligning, which means there will likely be more formal contracted relationships. However, the conversation cannot end there. These incentives are only the beginning of a challenging but exciting opportunity to change the health and social care landscapes.

Given the number of people who are in need of this help, and given the major differences in how healthcare entities and CBOs operate and think about these problems, they are going to need to think carefully about how to design a system that can truly make larger impacts on the health and quality of life of the people that they serve. It’s exciting to see these two worlds come together and start these discussions and it’s especially encouraging to see the impact these types of partnerships are going to have on those patients and community members that really need the help.

Part 3: A Blog Series on the Highly Anticipated CHRONIC Care Act

So What’s Going to be Reimbursed?

By Bella Kirchner, Special Projects Manager

As we’ve written about previously in Part One of this series, one of the most significant changes in healthcare reimbursement was CMS’ (Centers for Medicare and Medicaid Services) promise to start reimbursing Medicare Advantage plans for non-medical benefits beginning in 2020. Previously, supplemental benefits reimbursed by CMS for chronically ill beneficiaries had to be health-related services but they expanded that definition in the CHRONIC Care Act, passed back in April 2018, by stating that covered services “may not be limited to being primarily health related benefits.” Now referring to these supplemental benefits as Special Supplemental Benefits for the Chronically Ill (SSBCI), CMS recently provided more clarification in January 2019. Some of the main takeaways:

Defining Non-Medical Benefits

While CMS previously released additional information around uniformity rules and qualifying conditions related to SSBCI (which we summarized in Part Two of our series), health plans and industry experts have been waiting for further clarification on what’s actually considered a non-medical related benefit.

Some speculated that home modifications might end up being covered, but the document states that the non-medical benefits “may not include capital or structural improvements to the home of the enrollee that could potentially increase property value (e.g., permanent ramps, and widening hallways or doorways)…”. Although this leaves out reimbursement for major structural projects, this means that there is still some room for non-permanent solutions, such as temporary ramps or assistance with moving furnishings.

The document also includes several examples of what will be allowed for reimbursement, including the following:

It will be interesting to see how “food and produce” will be billed for, how these goods will be provided, and how they will be reimbursed.

While all of this information provides some clarification, questions still remain around other items and services, such as air conditioners, pest control, and mold removal. Where will CMS land on reimbursing for these services?

New Partners: Health Plans and Community-Based Organizations

In addition to clarification around benefits, the document also briefly discusses the potential role Community Based Organizations (CBOs) may take in the new reimbursement landscape. Coordinated care Medicare Advantage (MA) plans (HMOs, POSs, PPOs, SNPs) are already obligated to “coordinate MA benefits with community and social services generally available in the area served by the MA plan.”1 In addition to care coordination, CMS outlines two other ways in which these types of plans can partner with CBOs:

The continued push for health care plans and CBOs to work closely together is just more evidence of CMS’ growing interest in tackling social determinants of health.

CMS also states that Medicare Advantage plans must make sure they have rigorous and objective criteria for determining eligibility for SSBCI. They must also “maintain detailed documentation” to ensure that all patients are screened equally. Since CBOs will be able to help them with eligibility, they will have to think of ways to ensure that screening and documentation follow these requirements.

The Impact

One consequence of the allowances set forth by CMS is that the relationship between the health plan, healthcare provider, and CBOs becomes extremely important. If done right, this systemic approach to social determinants will mean that more people will get the social services they need outside of the doctor’s office, with support from both their health plan and their community.

Note: CMS is currently taking comments on the Proposals and Draft Letter through March 1, 2019. You can find more information here.

Check out part four of our blog series: The Rising Prominence of Community Based Organizations


1https://www.govinfo.gov/content/pkg/CFR-2010-title42-vol3/pdf/CFR-2010-title42-vol3-sec422-112.pdf