Harvard Business School.
NYU Grossman School of Medicine.
Milbank Q. 2021 Mar;99(1):171-208. doi: 10.1111/1468-0009.12491. Epub 2021 Jan 8.
Policy Points Health policies that encourage health and social integration can induce community-based organizations (CBOs) to adopt new ways of working from health care organizations, including their language, staffing patterns, and metrics. These changes can be explained by CBOs' perceptions that health care organizations may provide new sources of revenue. While the welfare implications of these changes are not yet known, policymakers should consider balancing the benefits of professionalizing CBOs against the risks of medicalizing them.
Recent health policies incentivize health care providers to collaborate with community-based organizations (CBOs), such as food pantries and homeless shelters, to address patients' social determinants of health (SDOH). The perspectives of health care leaders on these policy changes have been studied, but the perspectives of CBO managers have not.
Our research question was: How are CBOs in Massachusetts perceiving and responding to new Medicaid policies that encourage collaboration between health care organizations and CBOs? We interviewed 46 people in leadership positions at CBOs in Massachusetts for approximately an hour each. We analyzed these data abductively, meaning that we iterated between inductively coding transcripts and consulting existing theories and frameworks.
We found evidence of a knowing-doing gap among CBOs. Even though CBOs value their distinctiveness and autonomy from health care, they have undertaken a series of organizational changes in response to the new Medicaid policy that make their organizations appear more like health care organizations. These changes include adopting new performance metrics, hiring clinical staff to the board and senior management positions, and using medical language to describe nonmedical work. Drawing on institutional theory, we suggest that the nonprofits undertake such changes in an effort to demonstrate legitimacy to health care organizations, who may be able to provide new sources of critically needed revenue.
Massachusetts CBOs perceive health systems as potential sources of revenue, due in part to an ongoing Medicaid redesign that encourages the integration of health and social services. This perception is driving CBOs to appear more like health care organizations, but the impacts of these changes on welfare remain unknown.
政策要点 鼓励健康和社会融合的政策可以促使社区组织（CBO）从医疗机构采用新的工作方式，包括其语言、人员配备模式和衡量标准。这些变化可以用 CBO 的以下看法来解释：医疗机构可能提供新的收入来源。尽管这些变化的福利影响尚不清楚，但政策制定者应考虑平衡将 CBO 专业化的好处与使它们医疗化的风险。
最近的卫生政策激励医疗保健提供者与社区组织（CBO）合作，例如食品储藏室和无家可归者收容所，以解决患者的健康决定因素（SDOH）。已经研究了医疗保健领导者对这些政策变化的看法，但尚未研究 CBO 管理人员的看法。
我们的研究问题是：马萨诸塞州的 CBO 如何看待和应对新的医疗补助政策，该政策鼓励医疗机构与 CBO 之间的合作？我们对马萨诸塞州 CBO 的 46 名领导层进行了大约一个小时的采访。我们对这些数据进行了非定向分析，这意味着我们在对转录本进行归纳编码和咨询现有理论和框架之间进行迭代。
我们在 CBO 中发现了一种知行差距的证据。尽管 CBO 重视自己的独特性和自主权，但他们已经采取了一系列组织变革来应对新的医疗补助政策，这使得他们的组织看起来更像医疗机构。这些变化包括采用新的绩效指标、向董事会和高级管理层聘请临床工作人员，以及使用医学语言来描述非医学工作。借鉴制度理论，我们认为非营利组织做出此类改变是为了向医疗机构证明合法性，医疗机构可能能够提供急需的新收入来源。
马萨诸塞州的 CBO 将卫生系统视为潜在的收入来源，部分原因是正在进行的医疗补助重新设计鼓励将健康和社会服务整合在一起。这种看法促使 CBO 看起来更像医疗机构，但这些变化对福利的影响尚不清楚。
