How are Massachusetts Community-based Organizations Responding to the Healthcare Sector’s Entry into Social Determinants of Health?

Byhoff E, Taylor LA
Publication Year: 2018
Study Design: Other Study Design
Type of Literature: Grey

In Massachusetts, MassHealth is implementing a number of reforms as part of its most recent Medicaid 1115 demonstration waiver extension to transform the delivery of care for most members and address the social determinants of health (SDOH). In light of the new interface between healthcare and social service delivery fostered by the MassHealth program redesign, it is important to understand how community-based organizations (CBOs) perceive the entry of healthcare organizations into their domains of social service delivery. While healthcare providers’ perspectives are frequently reported on, less is known about how CBOs view the opportunities and challenges associated with these new relationships.
This report aims to address this knowledge gap by summarizing the findings from a qualitative study that sought to better understand how CBOs are responding to the healthcare sector’s movement into SDOH programming in Massachusetts. Data was collected through 46 key informant interviews with CBO representatives from a range of social service sectors across the state. Informed by the study findings, this report outlines recommendations for healthcare leaders and policymakers to support the integration of healthcare and social service delivery.

Insights Results


  • Report aims to understand how community-based organizations (CBOs) are responding to the healthcare sector’s movement into social determinant of health program in Massachusetts
  • Employed a key informant interview method to conduct 46 interviews with leadership and high-level program staff from a diverse set of CBOs, including ones focused on food, housing, and legal services across Massachusetts between September 2017 and March 2018


    • Identified 5 emergent themes: 1) CBOs perceive significant differences between their organizations and healthcare organizations in terms of how they conceptualize their work, determine eligibility, refer and receive referrals, measure impact, and the scale of there service delivery, among other operational and cultural distinctions; 2) Despite feeling largely excluded from the policymaking process to date, CBOs regard the implementation of Medicaid 1115 waiver as providing important financial incentives for healthcare organizations to address SDOH deficits among patients. CBOs anticipate that healthcare will do so in partnership with CBOs; 3) CBOs indicate that they view favorably the policy changes that transferred financial risk to healthcare organizations and spurred new interest in coordination between themselves and healthcare. This is seen as “movement in the right direction;” 4) CBO staff report a number of recent strategies adopted by their organizations that were intended to improve their organization’s positioning to partner with newly-formed MassHealth ACOs and gain access to their financial and political resources available to healthcare organizations; and 5) Amid deliberate efforts to position themselves in response to health care’s movement into SDOH programming, CBOs also report a series of risks and concerns about the impact that partnering with healthcare could have on their organizations and the social service sector as a whole
      Key Takeaways
    • Findings highlight strategic tensions that Massachusetts CBOs face as they develop strategies to respond to healthcare’s entry into SDOH. While CBOs may wish to grow, they want to prevent losing the aspects that make the CBO sector unique