Oregon Health Sciences University (OHSU) and Portland State University (PSU) School of Public Health

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7
Apr

Cross-sector partnerships present both benefits and risks to health services and human services

Cross-sector partnerships present both benefits and risks to health services and human services organizations when they work together to address social determinants of health

New study explores the complexities faced by health and human services organizations as they collaborate to address unmet social needs

The health services industry is increasingly aware of the need to understand, identify, and address the social determinants of health (SDH), non-medical factors that impact a person’s health, from a lack of secure housing to food, transportation, or other basic needs. But screening for SDH, as well as addressing the social issues a person is experiencing, have historically been viewed as beyond the scope of what health services organizations can do on their own 

While cross-sector networks of local health and human services organizations working together are increasingly seen as strategies to screen for and address SDH, these collaborations also bring their own challenges. They require organizations to adopt new business models in order to coordinate efforts, often resulting in real or perceived risks that can influence the ultimate success or failure of the partnerships.

A new study published this week in the journal Health Affairs explores the factors organizational leaders weigh when considering collaborative opportunities and the potential risks to reputation, sustainability, and compliance with regulatory or funder requirements. 

The study gathered perceptions of collaboration risk from the leadership at 22 health and human services organizations in Oregon. On the health services side, participants included primary care organizations, public health departments, dental practices, and others in care delivery that were conducting social needs screening of their clients as part of the Center for Medicare and Medicaid Services’ Accountable Health Communities project, led locally by the Oregon Rural Practice-based Research Network. On the human services side, the study included private nonprofit organizations such as food banks, aging services, and other community-based social service organizations poised to receive client referrals as a result of the social needs screenings.

Risk perceptions were manifested differently across both sectors, which has implications for the design, implementation, and governance of cross-sector initiatives. But while the research found differences in how health and human services leaders think about the risks of cross-sector collaborations, it also revealed opportunities to cultivate interprofessional understanding, build trust, and incentivize cooperation across sector lines. Screening and referral initiatives, such as the Center for Medicare and Medicaid Services’ Accountable Health Communities, that aim to coordinate health and human services delivery can also benefit from a design that incorporates the values and experience of both sectors and aims to balance the benefits and risks for all partners. 

The study was led by Dr. Shauna Petchel, a recent doctoral graduate in Health Systems & Policy at the Oregon Health & Science University–Portland State University (OHSU-PSU) School of Public Health, who is also a senior project manager at the Center for Health Systems Effectiveness at Oregon Health & Science University. Co-authors include Dr. Sherril Gelmon, a professor and Director of the Health Systems Policy PhD Program at the OHSU-PSU School of Public Health, and Dr. Bruce Goldberg, a professor in the OHSU-PSU School of Public Health and a senior adviser at the Oregon Rural Practice-Based Research Network (ORPRN) in Portland. 

About Dr. Shauna Petchel

Dr. Shauna Petchel recently defended her dissertation in the Health Systems & Policy PhD program at the OHSU-PSU School of Public Health, in which she demonstrated the application of a range of health services and system science research methods to this project. She is a recipient of the 2020 OHSU-PSU School of Public Health 2020 Excellence in Research award. Petchel graduated with an MPH in Health Management & Policy Program at Portland State University in Fall 2008.

“Shauna has built upon her interests in both health services and nonprofit management practice and research to complete an elegant research project that illustrates the perspectives of both health and human services leaders on organizational risks in cross-sector partnerships,” said Dr. Sherril B. Gelmon, Director of the Health Systems Policy PhD Program in the OHSU-PSU School of Public Health. “Her findings not only illuminate these two sets of perspectives, but also have implications for initiatives to address social determinants of health, in particular as seen in current CCO 2.0 efforts in Oregon.”

In addition to first author on the study, Petchel also wrote a blog post for Health Affairs, putting her study in the context of the current coronavirus crisis. In “COVID-19 Makes Funding For Health And Social Services Intergration Even More Crucial,” she discusses how the virus has made our safety net even more fragile and the need for holistic, coordinated responses more important than ever. 

Petchel will also be featured in Health Affairs’ “Infrastructure Needed for Integration of Health and Human Services,” one of three online-only events featuring panels of authors beginning April 16. These lessons of working together across sectors are particularly important as communities come together to fight the COVID-19 pandemic. Visit the Health Affairs website for times and details. 

A special edition dedicated to the integration of social services and health, the April issue of Health Affairs includes additional research and insight from experts, including a story from our partner Oregon Health & Science University on Project Nurture, a social services collaboration which improves outcomes for opioid-dependent mothers.