What new funding asks of a community partnership

What changed

In November 2023, CMS finalized a Medicare physician payment rule that included payment for qualifying community health integration services. Its announcement described work such as:

“facilitating access to community-based resources”

— Centers for Medicare & Medicaid Services, November 2023

The announcement (opens in a new tab) recognizes that connecting someone with useful support takes time and skilled effort. These are defined payment arrangements for qualifying services, not unrestricted grants to every community organization. As these payment arrangements begin in 2024, a potential partner needs to understand the applicable requirements before assuming its work can be funded.

Start with the connection someone actually needs

Consider a hypothetical partnership between a clinic and a neighborhood resource center. A participant wants to attend an appointment but cannot use the available bus route. The clinic has a list of transport services. The center knows which local options might fit.

Passing the list across is easy. Finding out whether a suitable ride exists, whether the person wants it, and how to arrange it is a different piece of work.

That distinction interests us at genus. A policy can recognize connecting work while leaving organizations with practical decisions about how to organize it. Begin with the person’s goal. They may prefer an appointment time that fits a familiar journey rather than a new transport arrangement.

Agree on the work before naming the partnership

A useful first discussion is quite ordinary: who will speak with the participant, check the resource, make the introduction, and respond if the arrangement falls through?

The answer should include limits. A community worker might help someone understand available options without making a clinical judgment or determining insurance eligibility. A clinic may retain responsibilities that cannot simply be passed to a partner.

Write down the agreed work in language colleagues can recognize during a busy day. If each organization imagines the other will follow up, a friendly introduction can become another unanswered message.

Put capacity into the funding conversation

Ask how much time the proposed service requires, including unsuccessful contact attempts, language support, supervision, and keeping information current. These activities can be easy to overlook when a partnership is described only by its successful introductions.

A funding opportunity should not quietly turn into unpaid work for the organization with the smallest team. Nor should a payment arrangement encourage staff to offer a service that the participant does not need.

Before making commitments, have the appropriate billing and program specialists examine eligibility, documentation, and responsibility. Then connect those requirements to a realistic staffing plan. A signed agreement is a beginning; someone still needs protected time to do the work.

Decide what happens when there is no suitable option

Sometimes the honest answer is that the requested resource is unavailable. A partnership needs a way to handle that answer without sending the person around the same circle again.

Agree who will explain the gap, ask about alternatives, and bring recurring problems into a service review. Keep the person’s preference visible. An available option is not automatically an acceptable one.

For leaders, these gaps can inform future planning. Describe them accurately rather than counting every referral as a successful connection. A clear account of unmet need is useful evidence, even when it is uncomfortable.

The person remains part of the decision

The participant should know why another organization is involved and what information will be shared through the appropriate arrangements. They may want a chosen supporter included, or may prefer to speak directly.

Give them a practical contact if the plan changes. Avoid making them coordinate the organizations’ agreement themselves. The point of recognizing this work is to make support more usable, not to add another relationship they must manage.

Where genus can help today

In a configured genus care app or care wall, organizations can share prepared resources, program updates, and appropriate next steps with their intended audience. Tasks and conversations can help participating people keep an agreed action in view.

Those capabilities need a service arrangement around them. genus does not establish Medicare payment eligibility or replace the responsible professionals’ billing and documentation systems. We see the useful contribution as keeping reviewed information and human responsibilities easier to find within the experience an organization has configured.

A question before the next introduction

If this person accepts our offer of support, can we explain exactly who will help, what happens next, and what we will do if the first option does not work?