When the WHI shifted its focus to investigating how our community could better integrate health and social services, there was an air of uncertainty lingering from the beginning. Kicking off at the December stakeholders meeting that closed out 2024, discussions among many of our stakeholders tried to predict what federal and state funding for types of initiatives would look like in the coming months as the federal government ushered in a new executive administration.
Despite the sense of doubt, stakeholders saw how other Community Care Hubs (CCHs) around the country had been launched and were slowly scaling, which drove interest in how a similar model could better integrate health and social services and build on the work of other local initiatives, like the Mi Community Care (MiCC) program.
Fast forward 6 months and the proposed 10-year, $1 trillion cut to Medicaid, along with slashed budgets for critical social services, has created stronger calls questioning the feasibility of planning and implementing a CCH in Washtenaw County. When health systems, community providers, community-based organizations (CBOs), and social service providers alike will be grappling with maintaining services and capacity in the face of sharp reductions in funding, how could we possibly look to take on such a large planning effort?
While skepticism continues to rise, the CCH model itself provides a potential tool to help mitigate these cuts. CCHs can help maximize existing resources, leverage a pooled and braided funding model, demonstrate the value of integration, and build a platform for collective advocacy.
Understanding the CCH Model
The Partnership to Align Social care defines a CCH as “a community-centered entity that organizes and supports a network of community-based organizations providing services to address health-related social needs. A CCH centralizes administrative functions and operational infrastructure, including, but not limited to, contracting with healthcare organizations, payment operations, management of referrals, service delivery fidelity and compliance, technology, information security, data collection, and reporting.”
Because of its unique structure and array of centralized, shared functions and resources, CCHs aspire to reduce the cost of care while also improving individual and population health measures. While the model offers operational flexibility to meet unique community needs, the general features of a CCH can help mitigate funding cuts.
Leveraging Cross-Sector Partnerships to Maximize Existing Resources
Perhaps the cornerstone feature of a CCH is its intentional connection of healthcare providers, social service organizations, CBOs, and public health into one unified network. In this connected environment, successful CCHs leverage a shared infrastructure that can reduce duplicative services, freeing up organizational capacity to ensure more people can be served with fewer resources.
For instance, in our current system, it is not uncommon for people with complex health needs and unmet health related social needs to be receiving services from multiple health and social service providers. At each provider organization, staff is dedicated to help coordinate care, perform intakes and assessments, and coordinate external referrals. Additionally, there are many times where these organizations are investing staff time assessing eligibility for services for people who end up not meeting criteria. They then perform additional work in trying to identify other resources that may be able to meet their needs.
These types of systematic complexity compound administrative costs and contribute to higher percentages of administrative burden that a CCH could help decrease. In a hub model, the CCH could provide centralized care coordination functions including eligibility verifications and managing the referral process allowing provider organizations to focus their resources on delivering the core services their organizations are experts in providing.
Enabling Pooled and Braided Funding
As a product of its organizational and partnership structure, CCHs are uniquely positioned to employ financial strategies that can pool funding from a wide range of funding sources that support its shared services while also providing funds to partner organizations for service delivery.
As another shared service of the CCH that relieves partner organizations of additional administrative burden, the hub would be able to identify, apply for, and administer grants, contractual agreements, and other funding sources to support services delivered by CBOs and other social service agencies.Given its connection to partner organizations, the CCH could direct funds to services that were affected by reductions in funding to help preserve service capacity.
Additionally, CCHs also have the administrative capacity and oversight to meet complex compliance and reporting requirements, making them more competitive for replacement funding opportunities or emergency response grants.
Demonstrating Value
We know that health outcomes are closely connected to having access to critical health related social needs, and that we can improve these outcomes by making sure patients’ social needs are met. Despite the research, the historically siloed nature of health and social service delivery has made demonstrating the value of better integration an elusive endeavor. While data are collected, fragmentation of the data separated by provider or funding stream has been a roadblock in documenting positive outcomes of truly person-centered care.
Because of its shared data infrastructure, not only can a CCH provide more robust outcome and evaluation reporting, but it can do it much more quickly. The ability to prove impact quickly and credibly becomes a major advantage that could help retain existing funding, attract alternative funding, and justify public investment even as funding shrinks.
Closer to real-time reporting can also be leveraged to take a more upstream, preventive approach to emerging health trends. In combination with the benefits of a pooled and braided financial strategy, public health professionals can identify emerging health issues quicker and have the flexibility to quickly direct support and targeted services to help mitigate any further escalation in the trend.
Providing a Platform for Collective Advocacy
Perhaps most critically, CCHs can provide a unified platform for cross-sector advocacy. In response to proposed budget cuts, CCHs can rapidly mobilize health care providers, public health officials, CBOs, and residents to advocate for sustained investment in critical services.
Rather than each organization advocating independently, CCHs amplify shared messages, highlight system-level impact, and often act as the convening backbone for regional advocacy coalitions. This can result in policy reversals, stopgap funding, or the preservation of critical services that might otherwise be lost.
Looking Ahead: From Uncertainty to Opportunity
The threat of deep cuts to Medicaid and social services has undeniably cast a shadow over the feasibility of implementing a CCH in our community. But in that uncertainty lies an opportunity. The very challenges that make the present moment so daunting also underscore the urgency and relevance of the CCH model.
Rather than retreat in the face of scarcity, our community has the chance to build something more sustainable, more collaborative, and more resilient. A CCH is not just a luxury for stable times, but could be a practical strategy for weathering instability, maximizing existing resources, and preserving access to care and support for our most vulnerable residents.