Community Care of Brooklyn (CCB), a network of more than 1,000 Brooklyn-based providers and community-based organizations, has teamed up with Unite Us to track and reimburse for social services.
The pilot will use Unite Us’ payments solution to track services and reimburse participating community-based organizations (CBOs). Through the pilot, CBOs are paid when working with qualifying individuals experiencing food insecurity, inadequate or unstable housing or difficulties navigating social services.
This marks the first time a payment infrastructure is added to the network’s referral service, known as CCB Navigator. It uses a custom needs assessment screening tool and the Unite Us platform, which offers closed-loop referrals between providers and CBOs, to connect patients to social services.
“We recognize that our network is really only as good as the CBOs that we have to refer to,” Danielle Cuyuch, CCB’s operations lead, told Fierce Healthcare. These organizations are “really struggling,” she added, and CCB wanted to support them.
The coordinated care network was originally launched in 2022 as a partnership between Maimonides Medical Center, Brooklyn’s largest hospital, and the Brooklyn Health Home. The latter is a Maimonides-managed entity that provides community-based care management services to individuals living with multiple chronic illnesses, as well as Unite Us.
CCB has received a grant that is funding the payments pilot, Cuyuch said. Once a CBO gets a referral from the network, it accepts it in the Unite Us platform, which then generates an invoice that gets sent back to the funder—in this case, CCB—for payment.
“It seems like something that would be very simple, but it’s infrastructure that a lot of CBOs don’t have,” Cuyuch said.
The pilot launches on the heels of the newly approved 1115 Medicaid waiver amendment in New York. The waiver aims to build a more resilient and integrated delivery system while addressing health-related social needs. It also calls on the development of social care networks—entities contracted in each region of the state to provide social needs screening and referral services.
Social determinants of health determine up to 80% of a person’s health outcomes. CBOs have long struggled nationwide with chronic underfunding, but stakeholders in New York hope that the new waiver will offer a more sustainable funding source for their work. The waiver is expected to be released around August, per Cuyuch.
Unite Us offers training for CBOs on how to use its platform and monitors its networks to ensure active use, Cuyuch said. CCB also reviews this data to help stay on top of referrals. Since launching with Unite Us in 2022, about 360 closed-loop referrals have been made on the platform through CCB, according to Cuyuch. The payments pilot will run through 2024.