Identifying a Strategic Direction in an Alternative Payment Model Future

With state and federal dollars, healthcare providers are increasingly incentivized to address the socioeconomic factors leading to poor health through partnerships with community-based social service organizations (CBOs). Yet access to such financial incentives has been limited for CBOs. CAMBA, a Brooklyn-based CBO, delivers services that providers and managed care organizations (MCOs) are required to offer in emerging value-based reimbursement models that pay for services not traditionally considered healthcare. Yet CAMBA, like most CBOs, has struggled to establish reimbursement agreements with providers and MCOs. CAMBA engaged a Capstone team to develop a plan to establish such reimbursement agreements. The team also advised CAMBA on which of its 160+ programs are the best candidates for the value-based payment model. The team reviewed existing literature and evaluated the New York market through a series of qualitative interviews with experts in the field. The team made recommendations about which of CAMBA’s existing services are the best candidates for provider or MCO partnerships and how these programs can best position themselves for such partnerships.