Editor’s note: The SCAN Foundation, The John A. Hartford Foundation, the Administration for Community Living, the Gary and Mary West Foundation, the Marin Community Foundation and the Colorado Health Foundation have united to fund a three-year grant to develop and establish the Aging and Disability Business Institute, housed within n4a. Under the grant, ASA and n4a are collaborating on a series of articles in Aging Today that will help to prepare, educate and support aging and disability community-based organizations and healthcare payers to provide quality care and services. This is the third in a series of case studies of organizations in the midst of evolving their business models.
The St. Barnabas Senior Services (SBSS) mission states that the elders they serve should “Live Well, Feel Well, and Age Well in the community with dignity and respect.” And its President and CEO Rigo Saborio is taking action to ensure that mission continues, in a fully integrated model of service.
Serving a base that mirrors its Los Angeles location, SBSS older adult clients are 35 percent Asian, 33 percent Latino, 25 percent white, 6 percent African American and 1 percent other ethnicities. This organization, which is more than 100 years old, provides home-delivered meals, hot lunches, groceries, case management, counseling, depression intervention, wellness education, healthcare referrals, housing and housekeeping assistance, as well as referrals to other community resources.
To serve its approximately 18,000 clients, SBSS now runs three senior centers, manages 14 meal sites and operates a mobile technology lab to train and assist older adults with computer use. All this is accomplished with a lean staff of 70, and help from more than 100 volunteers.
A First Step Toward Integrated Care: Joining the Linkage Lab
SBSS garners revenue through government contracts, with dollars from the Los Angeles Area Agency on Aging making up 60 percent of their revenue and the remainder coming from foundation support. Saborio says they were looking for ways to strengthen their financing through new partnerships, potentially with healthcare entities, when 18 months ago they joined The SCAN Foundation’s Linkage Lab Academy, after making what he calls a “philosophical commitment to becoming a fully integrated model.”
“Despite adding responsibilities to our staff members who comprised the team that was part of the Linkage Lab process, it was a worthy investment of time,” says Saborio, as SBSS now understands how to communicate effectively with the healthcare sector, has learned which tools to use for internal assessments and has determined the healthcare sector’s need for SBSS’s services. The organization also better understands its strengths and weaknesses, and how to bridge the gap between them to become an effective partner.
“The Linkage Lab Academy helped give us those building blocks, tools and foundation so we could then hone in on thinking about who we partner with, and how,” says Saborio. Academy consultants worked directly with the SBSS team, helping them think through what service model they wanted, how to put together a five-year budget analysis based on revenue-cost modeling and how much time and money it would take to break even.
Saborio found this last bit particularly important as SBSS is considering seeking seed money from a foundation to help launch their integrated model. They anticipate a deficit over the first few years, so the Academy’s cost models helped the team identify the size of the anticipated deficit and thus how large a grant to request.
Progress Made on the New Model
SBSS is still developing their pilot model with a health plan and a medical group and also is in conversation with a hospital. Through their work with Linkage Lab Academy, SBSS discovered how they might work with the healthcare sector to become a more fully integrated service model, and how to achieve better client outcomes, e.g., preventing hospitalizations and emergency room visits through addressing social determinants of health.
They zeroed in on what type of collaborations might work best, identified the players in their service space and then reached out to groups with which they already had a history. At one point, SBSS had an adult day health center through which they had already built relationships with health plans, so they reached out to those plans, and used the same process with hospitals and doctors they knew through making client referrals.
In these conversations, SBSS was able to “organically identify what [the health plans’] needs are, and how a CBO [community-based organization] like us might be able to address them,” says Saborio. He and his team then analyzed their current competencies and, with additional lessons from Linkage Lab, created a service model that was not too much of a stretch from their current model.
Lessons Learned Thus Far
Despite being early on in the process of developing a fully integrated model and securing partnerships with healthcare entities, Saborio has some wise advice for others just beginning the process. First, such collaborations take time. When SBSS began the Linkage Lab process, Saborio thought they’d have a contract established by the end of 2016. As that has not happened, he says one of the initial lessons is to manage one’s expectations. Lightly staffed CBOs have so many demands on staff and leadership time, it is important to realize from the beginning that the process is lengthy, and will require patience and stamina.
The healthcare sector also has its share of pressures, which includes the directive to achieve the Triple Aim: improve patient experience, elevate population health and reduce costs. Saborio describes dealings with such partnerships as a “fine dance.”
“[Though] they’re not already part of the healthcare process, social service agencies must realize they bring value to the table and have that confidence coming into the conversation,” says Saborio. “You’re already in the community, you’re trusted by the community, you know the community better than healthcare plans and private contractors … that trust is of tremendous value.”
Editor’s Note: This article appears in the January/February 2017 issue of Aging Today, ASA’s bi-monthly newspaper covering issues in aging research, practice and policy nationwide. ASA members receive Aging Today as a member benefit; non-members may purchase subscriptions at our online store.