Report Highlights How Nonprofits Perceive the Health Care Sector’s Work to Address SDOH

by Kim Prendergast Health & Nutrition Consultant, Feeding America

The Blue Cross Blue Shield Foundation of Massachusetts recently released a report on their findings of how community-based organizations (CBOs) perceive the entry of health care organizations into their domains of social service delivery. Through “How Are Massachusetts’ Community-Based Organizations Responding to the Health Care Sector’s Entry into Social Determinants of Health?,” the authors interviewed dozens of nonprofit organizations providing food, housing, legals services, and more.

From these discussions, five themes emerged:

1) CBOs perceive significant organizational and cultural differences between the way those in the health care and nonprofit sectors approach this work. From speaking the same language, accomplishing work on a different “scale”, and the resources which are perceived to be available vary widely, as does the ability to change and respond to community needs.

2) CBOs haven’t been engaged in the policy making process to date. However, they view the implementation of new Medicaid 1115 waivers to allow for reimbursement of additional services as a positive step for providing financial incentives to address SDOH deficits in partnership with CBOs.

3) CBOs see policy changes that transfer financial risk to health care organizations as moving in the right direction, spurring new interest in care coordination. Leaders view these changes as an opportunity for the nonprofit sector to access grants or contracts to provide services to patients in need.

4) CBOs are adopting strategies to better position their organizations to partner with the health care sector, including hiring staff, shifting their outcomes to more closely align with health care, conducting and using research to inform their planning, and creating a “Menu of Options” of programs through which they can engage health care partners.

5) There are concerns about the impact that partnering with health care sector will have on the nonprofit sector. Those include the availability of funding, capacity of the CBOs to plan for and accept a large number of referrals, and the ability to stay true to their mission while working in partnership with the health care sector. In addition, CBO leaders expressed concerns about the challenge to negotiate favorable contracts when they are working with large institutions.

While the authors of the report interviewed CBO leaders in Massachusetts, a Medicaid expansion state that has adopted progressive policies regarding health insurance coverage, the themes in this report are ones that Feeding America hears from food banks across the country. The need to learn to speak the language of the health care sector, build internal capacity to support partnership activities, and craft a portfolio of programs and interventions that will be appropriate to address the food security needs of patients coming from different health care settings is universal across the food bank network.

Rachel Stankiewitch, Director, Agency Relations and Programs, shares that these themes resonate with the work of the Second Harvest Food Bank of Central Florida, as well.

“Despite Florida’s lack of adopting 1115 waivers and being a non-Medicaid expansion state, the healthcare sector has made a shift in focus on supporting programs that address the social determinants of health. Since late 2016, Second Harvest Food Bank of Central Florida has been convening a Health & Hunger Task Force, a coalition of local nonprofit healthcare providers and nutrition and health-focused organizations, who collaborate on developing sustainable solutions to address food insecurity as a social determinant of health. One of the ways Second Harvest is incorporating the health of the community into its core work is through the development of the Healthy Pantry Network. By leveraging our large network of feeding programs, a group of pantries are participating in capacity building efforts that allow them to provide healthier foods and nutrition education for people referred from clinics, hospitals and doctors’ offices.” More information on the Healthy Pantry Network can be found at

Kim Prendergast supports Feeding America and its member food banks with partnership development, technical assistance and strategic consulting to strengthen health care partnerships and Community Kitchens as a means to improving access to healthy food and ending hunger.