Lifting the Veil: How Networks Form, Operate, Struggle, and Succeed

Abstract

Organizational networks have become an increasingly prominent approach to the provision of services for complex, multi-dimensional needs such as behavioral and mental health needs, HIV/AIDS, substance use disorders, and services for people who are unhoused. This model is also taking hold among community-based organizations (CBOs) seeking to work with each other and to contract with health care entities to improve coordination, reduce fragmentation, and increase the efficacious integration of health and social support services for older adults and people with disabilities. There are very few studies that document how networks form, operate, and succeed in these cross-sectoral collaborations. This qualitative study was designed to fill that gap.

Interviews with 23 representatives of 8 distinct CBO networks (including network hubs and network members) yielded the following major findings:

1. The formation of CBO networks for contracting with health care entity partners is an evolving and expanding approach. The perceived values of a network include the opportunity to collaborate, to build a more integrated system, to centralize administrative functions, and to better serve clients. Networks emerge in response to context-based opportunity, necessity, or both.

2. The level of formality in network roles, relationships, and governance structure varies, sometimes related to the newness of the network and the legal structure of the network hub.

3. A very common challenge for networks is the efficiency, functionality, and accessibility of the data ecosystem. Many networks build their data infrastructure on existing systems used by the CBO members and/or the network hub, which does not always map well to the needs of the entire network (health care entity, hub, and members).

4. Important tips for network success emerged from this study, including the need for value propositions and cost-benefit analyses for the network hub and members; the importance of transparency and accountability in all network operations such as referral volume and process, and contract negotiations; and the need for data systems that create data channels that are efficient and accessible for all organizational participants.

The rich information shared by the participants in this study also pointed to best practices and to technical assistance and resource needs that require further study and action.