AMY WILLA, C.J. HAGER | EHF
In 2023, the Texas Health and Human Services Commission (HHSC) released Non-Medical Drivers of Health Action Plan, outlining goals and strategies for addressing the social conditions that influence health and wellness—where people live, work, and play. By focusing on food insecurity, housing, and transportation, this Action Plan marks an important step toward recognizing the health impacts of non-medical drivers of health (NMDOH) and inviting partnerships beyond the traditional health care sector.
For the Episcopal Health Foundation (EHF), HHSC’s NMDOH Action Plan reaffirmed a core principle of our work: addressing the root causes of poor health requires tackling factors outside of the health care system that shape health outcomes. Promoting successful partnerships between food-related community-based organizations (CBOs) and Managed Care Organizations (MCOs) that prioritize coordinating health care services will take us one step closer to improving health for all Texans.
EHF partnered with the Baylor Collaborative on Hunger and Poverty to map the landscape of Texas-based food organizations and identify potential partnership opportunities between CBOs and MCOs.
The Collaborative identified and surveyed:
Follow-up interviews were conducted with
Findings
The findings from these surveys and interviews offer valuable insights into strengthening partnerships between MCOs and community-based food organizations.
Most survey responses were nonprofit organizations.
Organizations Surveyed (by type)
Most organizations report that providing free or low-cost groceries is their primary focus.
Organizational Activities to Address Food Insecurity
Just 7.5% of respondents reported that they are either currently working with an MCO or had worked with an MCO in the past.
Of the 251 organizations who disclosed whether or not they have partnered with an MCO, just 19 organizations reported that they are either currently working with an MCO or had worked with an MCO in the past. Of those 19 organizations, most were considered ‘mid-size’ (serving 101 – 1,000 people/month). These organizations were given an opportunity to describe their partnerships with MCOs. The following list represents some ways CBOs indicated how they partner with MCOs:
- Partner with MCO to do health screenings at their mobile food pantries
- Partner with local hospital to get health information out to community
- Trial program delivering produce to people on dialysis
- Medically tailored meals for patients with cardiac issues and diabetes management
- Produce prescriptions
- Nutrition education
- Home food delivery for seniors
- Cooking demos
- Food FARMacy to manage food-related illnesses
- Partner in community farmers market
Throughout the survey and interview process, we were able to note several key challenges associated with partnering with an MCO:
- scheduling or availability of the MCO
- customer service for billing issues
- reporting complexities
- tracking patient outcomes
- a lack of understanding by MCOs about how food banks work
- MCOs not understanding all the programs offered by CBOs
- Availability of appropriate food
More than three out of every four of respondents (78.4%) indicated that they were willing to partner with an MCO in the future.
One of the main goals of The Collaborative’s survey was to understand organization’s willingness to partner with MCOs, especially if they had not been involved in such a partnership already.
We also asked respondents what barriers they thought would exist to partnering with an MCO. The survey found that larger organizations were more likely to say they would be interested in partnering with a Managed Care Organization (MCO), and smaller organizations were more likely to report barriers to partnership. For over half of the respondents, funding and resources, lack of volunteers/employees, or a lack of information about what an MCO is or does would be barriers:
Barriers to CBO-MCO Partnership
We were also interested in who is most interested in partnering with MCOs in the future. We found that the size of the organization seems to influence willingness to partner in the future, with the willingness to partner increasing as the size of the organization increases:
Interest in Future Partnership with MCOs (by organizational size)
Food organizations tend to know their population intimately and have established, trusting relationships with their communities.
Geographically, though most of the organizations that were surveyed serve one or two counties and only 4% serve 10 or more counties, some organizations reported serving both rural and urban areas. This could be challenging for collaborative work because communities and their needs differ across geographies, and partnerships between food-related organizations will require nuanced and tailored approaches, which often take more time to establish and more labor to maintain. Further, Texas’s managed care service areas are multi-county, and their organizational strategy will reflect this.
Recommendations
Based on the findings in the report, as well as others that have looked at similar partnerships, the Baylor Collaborative offers the following recommendations:
- Develop educational material to help MCOs and CBOs better understand each other
- Invest in relationship building between MCOs and CBOs
- Work to overcome CBO size-based barriers
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