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Payers Redesign Referral Networks for Social Determinants of Health

It is time for payers to bring community-based organizations to the table of community health and to work alongside them to strengthen referral networks.

Kelsey Waddill
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Published: 21 Aug 2020

As Blue Cross and Blue Shield of Kansas City (Blue KC) relied on its social needs referral network to meet regional social determinants of health demands during the coronavirus pandemic, the payer watched its relationship with community-based organizations transform.

A payer referral network that is built on long-standing, trusted relationships with community-based organizations and that works with—not just for—these organizations will be a stronger network, Blue KC found.

Kansas City, Missouri faced numerous social determinants of health barriers, even before the coronavirus took hold in the US. However, like the rest of the healthcare industry, the coronavirus pandemic highlighted and intensified the hurdles for healthy living.

“Two things that seem to have risen to the surface during the pandemic were financial hardship and then the other is food access,” Jerry Jones, director of community health at Blue KC, told HealthPayerIntelligence.

Financial hardship could be expressed in a variety of challenges, Jones clarified. These included unemployment, reduction of work hours, housing stability, and inability to pay utility bills.

Food challenges were also more complex than finding and acquiring healthy, stable food. In addition to that, one of Blue KC’s major concerns during the height of the pandemic was establishing a secure emergency food system, catering to allergies for frontline workers and community members with food access issues, as well as providing contactless delivery.

“Pre-pandemic, those were things that were also at the top, but then what we've seen in the wake of COVID-19 was an increased demand,” Jones explained.

But previous relationship-building with community-based organizations meant that Blue KC already had a strong start to meeting those mounting demands.

“Blue KC has long-standing relationships with several community-based organizations. With Healthify’s network development support, my team has been fortunate in that we have been able to leverage these existing relationships—as well as our own relationships with these organizations—to stand up the social needs referral network,” Jones explained.

The social needs referral network

The social needs referral network is a collection of community-based organizations that have partnered with Blue KC and that target social determinants of health needs in the Kansas City area. When Blue KC employees and provider partners come across a patient with a social determinants of health barrier, they can refer patients to these organizations.

In the spring of 2020, Blue KC launched an electronic platform to unify organization efforts, streamline social determinants of health screening data, and help Blue KC employees and provider partners more easily identify nearby community-based organizations that can meet particular patient needs.

“We built it with that understanding of this network truly as a regional network. It'll serve Blue members, but it will also serve much more than Blue members,” Jones shared.

Blue KC has incentivized advanced primary care provider partners to offer social determinants of health screenings in order to collect more data on what barriers patients face. This population-based data is key to formulating solutions.

The model of having a referral network of community-based organizations connected by a single electronic platform is not new in the payer industry overall. However, Jones said that it is not as common for a commercial payer—as opposed to government-funded payers—to have a network like this.

Steps to reimagining the payer-CBO relationship

For payers looking to better engage their community partners, Jones recommended being ready to re-imagine the relationship altogether.

In order to reimagine that relationship, a payer—as a company—must establish a strong commitment to the community. But they also have to solidify and commit to what they want their role in the community to be.

Before 2018, Blue KC senior leadership emphasized its commitment to community health by establishing a team dedicated to that goal, Jones said.

At the intersection of community needs, provider and partner needs, and payer needs is where the social referral network can begin to grow.

In order to identify those gaps and reimagine the relationship, establishing trust with partners is also key, Jones added.

“Without the relationships that Blue has established, I don't see how this network would be possible,” he explained. “I would highly suggest that others start with relationship-building before trying to build a network. The relationships are going to be what matters in that.”

How to build community health alongside community partners, not for them

Implementation of the social needs referral network marked a pronounced shift in the way that the payer relates to its community partners.

“What we're saying as an organization to these community-based organizations is that we recognize the work that you're doing to keep people well and keep people home. We want to build the future of health in this region with you and not just for you,” Jones said.

This mentality allowed the relationships within the network itself to evolve as the pandemic escalated. Blue KC’s community partners began to coordinate their efforts.

“It’s been really fascinating watching these community based organizations innovate on the fly,” said Jones. “They’re prototyping different solutions, they're testing things out, they're tweaking, and now maybe starting to even communicate with each other and share ideas.”

Blue KC participated in facilitating collaboration between community-based organizations.

“Gatherings of nonprofit organizations by region and by focus area are a part of our network development and management strategy,” Jones shared.

As a result of the electronic platform and collaboration between community-based organizations, the payer was able to assess member risk using a combination of claims data and social determinants of health data for the Kansas City area during the pandemic.

This helped Blue KC target its response to the coronavirus, delivering care packages to those who were at risk and coordinating contactless food delivery for those who tested positive.

Going forward, Blue KC plans to roll out a health equity dashboard to observe the state of and changes in health equity in the Kansas City area, again through incentivizing social determinants of health screenings with advanced primary care provider partners.

Blue KC’s vendor platform also has the capacity to identify needs met versus needs unmet, quantifying the Kansas City region’s progress on social determinants of health and health equity.

This will be crucial for community-based organizations in two ways.

First, it will help eliminate redundancies in what community-based organizations are offering so that they do not have to stretch themselves even thinner to offer a service that is already being provided by another organization. In a phrase, the goal is: coordinated community care.

Second, it will provide quantifiable and organization-based data that these non-profits can use to apply for grants and funding from philanthropic institutions.

When looking to the future, Jones expressed the broader impacts that this kind of a model could have.

“The future of community health will clearly have payers at the table, we'll have our clinical partners at the table, and it must include community based organizations,” Jones emphasized.

“In the future, we have to be mindful of the role that they play in keeping our people healthy. More than anything, I just want to salute them. And I want us as a group of payers to really begin to reimagine what our relationship with community based organizations can and should be.”

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