ManagedCareSupplement3

GENERATIONS – Journal of the American Society on Aging

New Reimbursement Mechanisms Are Driving New Levels of Competition By Lori Peterson

In a shifting healthcare sector, value-based care reigns: how best can CBOs remain relevant?

A s has happened in virtually every other industry, changing healthcare system dy­ namics (from volume to value, a rising emphasis on wellness and the influence of the social determinants of health, regulatory change, and rising consumer expectations) are attract- ing non-traditional competitors from outside the sector. The effect of new entrants such as technology giants and startups seeking to make the delivery of healthcare more efficient and affordable cannot be underestimated. While this situation may feel a world away from the day-to- day realities of managing a community-based organization (CBO), the truth is the landscape has already become more complex as new com- petitors capture more market share; and the path forward requires CBOs to develop new capacities and execute new strategies to secure new opportunities. CBOs that prepare for, navigate, and suc- ceed in this evolving landscape stand to reap the rewards by serving more individuals in need (i.e.,

mission expansion) and acquiring new clients (i.e., market expansion).

Opportunities of the Changing Healthcare Landscape

Payers—whether Medicare and Medicaid or commercial health plans—have taken the lead in shifting the reimbursement model away from delivering services toward delivering value. Be­ cause spending too much on medical care that produces average outcomes is unsustainable, payers are creating models that move risk to providers who cannot demonstrate value, while financially rewarding those who can. Better access to quality medical care and improved economic conditions, psychological well-being, good nutrition, and safe housing are linked to better outcomes. Concentrating on improving these social determinants of health presents new potential for social service delivery, new opportunity for organizations to provide these services, and a push for healthcare organiza-

abstract As has happened in many industries, changing healthcare system dynamics (from volume to value, an emphasis on wellness and the influence of the social determinants of health, regulatory change, and rising consumer expectations) attract non-traditional competitors. The effect of technology giants and startups seeking to make healthcare delivery more efficient and affordable has made the landscape more complex for community-based organizations (CBO). CBOs that prepare for, navigate, and succeed in this landscape will reap the rewards; thus, they must develop new capacities and execute new strategies to react to new opportunities. | key words : community-based organizations, healthcare sector, competition, partnership, growth

54 | Spring 2019

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