How do we develop effective internal and external partnerships to meet the needs and build on the assets of our population?
If you are working to blaze a trail in this area, start with what differentiates your program and make the value proposition resonate with potential partners. If you are lucky enough to have tremendous proof of an ROI then lead with that. If you don’t have proof of ROI, then lead with your strengths. Highlight what your value-add is in terms of the delivery of service or quality or patient experience that is measurable and robust. It may or may not open their wallets, they may or may not be inclined to hire you on as a project, but it’s a really good starting point. Organizations starting out in this work should play to their strengths and be very committed to having good data on what they do well, and why their program is different and an additive value to what the current system provides.” Ken Coburn, MD, DrPH, FACP, President, CEO, Medical Director, Health Quality Partners
Why is this important? And what do we know?
- Individuals with complex needs and high costs often are faced with challenges that reach beyond the health care system, including poverty, trauma, mental health needs, substance abuse, cognitive disorders, and homelessness. Social determinants of health have a larger impact on health outcomes than health care itself, and the health care system is not set up to address most social determinant needs. Community-based and social service organizations provide such services and work to improve on the social determinants of health.
- It is crucial that care teams in enhanced care models identify unmet patient needs, seek community resources that serve those needs, and establish effective partnerships with those organizations to help patients reach good health outcomes at the lowest possible cost. Many health care systems have multiple programs and resources designed to provide more support to vulnerable patients, yet most programs remain disconnected from each other. It is equally important to forge strong partnerships within an organization’s own disparate departments as is it is to partner effectively with organizations and groups in the community. Enhanced care models that do not include primary care physicians on the core care team, but instead leverage externally-sited primary care support, need to forge partnerships with primary care as well.
- Effective partnerships are built on open communication and development of trust over the long-term. Whether the care team strengthens a partnership inside or outside the organization, the partnership will be built on the same foundations.
Characteristics that forge effective partnerships include:
- Capacity to develop shared purpose with other groups, including the ability to expand one’s vision to encompass others’ visions.
- Openness to meet in person and engage in ongoing and open communication (i.e., between program directors and care delivery staff of the different departments or organizations).
- Humility and ability to listen to others.
- Core activities of effective partnerships include:
- Identify overlapping patient populations served by teams from all partner organizations.
- Learn about how each team serves patients or clients. What services does the team deliver? Who directly serves patients? What eligibility criteria does each team have in place, and why?
- Verbally recognize the contributions that the partner makes to the health and well-being of the patient population.
- Identify and discuss any potentially competing priorities among partners.
- Develop shared goals, including deciding on a population of focus and defining a measurable and time-bound aim.
- Determine the scope of the partnership. Be clear about capacity from the beginning: how many people can the partnership organization teams serve in collaboration? Continually plan around matching capacity to demand for services.
- Commit to sharing data, which may require extended legal support and negotiation for teams that report to different organizations.
- Test collaboration strategies together, leading to the development of shared work processes. This often includes developing shared or complementary assessment processes and honing referral processes that include feedback loops to ensure communication.
- Hold monthly collaborative case conferences to bring members of different care teams together to solve problems, learn about each team’s care delivery, try out new ways to serve individual patients, develop work processes to shape care delivery for all patients, and identify areas to advocate for systemic change.
- Commit to developing shared decision-making methods. This might involve a commitment that those who attend a meeting are empowered to make decisions, rotating leadership from partner teams, or election of a lead decision-maker.
- Build cohesion among partners. Celebrate successes, acknowledge contributions by all partners, and create opportunities to gather together to develop relationships beyond the work.
How to get started strengthening partnerships
Overall tips and guidance
- Leaders of the enhanced care model must take an outward-facing position, clearly communicating the value of the model within and outside the organization.
- Resist the temptation to create new services before the team has investigated existing services in the organization and community.
- Adopt an asset-based approach to understanding the community’s strengths and assets, making sure to include a review of internal organization assets.
- Whether your team is partnering with other departments in your own organization or with external organizations, the value of consistent, open, and frank communication cannot be overstated.