Partnership Best Practices to Address Health-Related Social Needs

Status: Past Project
Year: 2021
Location: Massachusetts
Client: Health Care (including hospitals and health systems)
Services Provided: Assessment and Planning
Technical Expertise: Public Health-Health Care Integration

In 2020, MassHealth (a combined agency of the Massachusetts Medicaid and Children’s Health Insurance Program) launched the Flexible Services Program (FSP), a three-year initiative to pilot evidence-based approaches that address a member’s social needs around food insecurity, housing instability, and homelessness. The goal of the FSP is to address the health-related social needs of MassHealth members through its Accountable Care Organization (ACO) program. The program aims to improve health outcomes and reduce the need for costly medical care by building upon the expertise and assets of community-based social service organizations (SSOs).

Community Care Cooperative (C3), an ACO in Massachusetts, engaged HRiA to tell the story of their approach and partnerships with SSOs as part of their Flexible Services Program. Understanding how ACOs participating in the FSP implement the program, and whether meeting the health-related social needs of their patients through partnerships SSOs reduces health inequities, is key to supporting continued public investment in this type of program. This report strengthens the narrative around the flexible services model and illustrates how this model helps health care organizations achieve their mission around addressing the social determinants of health for their members or patients.

The report outlines unique aspects of C3’s program and highlights key elements of successful partnerships, the anecdotal and quantitative impact of the program, and tips and learnings for other SSOs and healthcare partners.