A Better Way to Do Good: The Case for Comprehensive Community Care

Months after watching the series Maid, I am still thinking about it. The series is based on the true story of a single mother who flees an abusive partner only to meet obstacle after obstacle as she navigates a system that’s ostensibly meant to protect and provide for her and her young daughter. Sadly, this portrayal of poverty, homelessness, and frustration while seeking help is an honest one. The way our social good ecosystem currently functions leaves many applicants bouncing between unconnected organizations, retelling painful stories, and receiving disjointed care.

And participants are not alone in facing challenges in this process. Nonprofit organizations and public sector agencies—”especially those involved in child welfare, mental health, and other direct services”—are often unable to increase workers’ pay like the for-profit sector, and their employees are burned out. While other industries have modernized and put technology at the center of operations, social good organizations are still often run on stacks of paper, making it all too easy for participants to get lost in the shuffle. As a result, the health and well-being of our most vulnerable citizens suffer.

The social good industry is long overdue for an overhaul of the user experience and must find a better way to do good now—when our communities need us more than ever. Today, 100 million people (about a third of Americans) live below 200 percent of the federal poverty line. This means that “a short-term illness, loss of income, or emergency expense can be insurmountable,” causing “economic insecurity and worse outcomes in education, health, and all other dimensions of well-being,” according to research conducted by PolicyLink and the Program for Environmental and Regional Equity (PERE) at the University of Southern California.

The COVID-19 pandemic has exacerbated the strain on an already overtaxed system by increasing demand for services while choking supply and compounding the effect of intersecting racial, social, economic, political, and personal barriers to receiving care. According to the FEMA report, “COVID-19’s Impact on the Human & Social Services Sector,” 50 percent of nonprofit organizations experienced increased demand for programs and services while 83 percent suffered financially, 75 percent canceled a major fundraising event, and 64 percent were forced to cut back on programs in 2020.

We need transformative thinking that fundamentally changes the way social good is delivered. What does that mean? Putting the right tools and processes in the hands of social good providers. We need a wholesale shift in our philosophy and practice for delivering social services—one that systematizes the power of collaboration and facilitates individual agency in order to create healthier, more equitable communities.

Imagine a social good ecosystem where case managers can immediately locate an individual’s file, understand the individual’s story, visualize the web of additional providers supporting them, identify the right next step to continue their care, and support them in taking this step, all in one click. Imagine the time case managers could save and redirect to valuable efforts. Imagine the program participant experiencing delight instead of despair as they feel heard and seen. Imagine families enhancing their income and quality time together because navigating services no longer takes days, weeks, or months. Social service nonprofits could make the kind of impact that thrills funders and helps people transcend survival mode and take control of their futures.

At Bonterra—a company that brings together tools and technology built to support the social good sector, where I serve as CEO—we’ve seen and experienced the benefits that can be accomplished through a comprehensive community care approach. We believe that such an approach is an important part of health justice, but its intention can only be achieved if we modernize technology across the industry to enable data collection, program efficiency and visibility, and coordination of care. We must leverage automation and analytics to make better and faster decisions and, above all, use these tools to address the whole person in a complex environment instead of playing an endless game of whack-a-mole as each new emergency arises.

 

The Promise of Comprehensive Community Care

Comprehensive community care leverages advanced technology to connect, measure, and enhance service delivery for the health and wellbeing of our communities. The goal is to create a trusting environment in which people in need may readily receive coordinated care from multiple sources.

Three things must be present to enact comprehensive community care:

·      Coordination across people and programs

Leaning on technology can help create frictionless handoffs between organizations in the care network and shepherd participants through their care journey. To capitalize on technology, the industry must develop common language and integrated systems that make whole-person health the standard of care. We must rethink social good delivery from a people-centered perspective, designing the system with the participant’s experience top of mind and acknowledging that needs are complex and interrelated.

·      Access and visibility for stakeholders and participants

The adoption of appropriate digital tools has the power to revolutionize operations, build trust amongst program participants and stakeholders, and offer more agency to those who depend on services. The importance of digital tools is driven home by the critical role virtual service delivery and communication play in our pandemic and post-pandemic world.

·      Standardized measurements and accountability

We need common goals and metrics across organizations, funders, and communities so we can track progress toward objectives like reducing poverty, improving education, and boosting community health.

 

The Case for Comprehensive Community Care

Our current approach to service delivery has four key system failures that thwart progress in making our communities healthier and more equitable.

System Failure 1: Human needs are multidimensional and interdependent, but the system is built for silos.

Unfortunately, the traditional approach to social services is to provide point-in-time relief with a single targeted service. For example, locating a bed for one night is a win, but it doesn’t address the mental health, income, and educational needs of the individual experiencing homelessness. A McKinsey report found that “individuals with poor mental health are 1.9 times as likely to report not receiving the healthcare they need, and 2.5 times as likely to report having multiple unmet social needs.” 

The social good space should take a holistic approach to health. The US Department of Health and Human Services defines whole person health as “looking at the whole person—not just separate organs or body systems—and considering multiple factors that promote either health or disease. It means helping and empowering individuals, families, communities, and populations to improve their health in multiple interconnected biological, behavioral, social, and environmental areas.”

System Failure 2: The burden of care coordination falls on vulnerable service seekers.

As the Maid series so poignantly depicts, the program participant journey is often disjointed. The onus is on the individual to overcome obstacles in the process, even though they’re already carrying a heavy load.

To illustrate, imagine that you need to apply for disability services, but you don’t have access to transportation, internet, or health insurance. To add another layer, you are also responsible for bringing together all the care and services you will need. For example, a single parent who needs housing assistance, affordable childcare, and disability support has to do the heavy lifting of accessing these services individually. There isn’t a unified process that connects services in one place for the care seeker, but there desperately needs to be.

Such circumstances are not uncommon. According to the ASCE 2021 Report Card for America’s Infrastructure, 45 percent of Americans have no access to transit. More than one in six poor Americans have no Internet access. And “in 2020, 8.6 percent of Americans, or 28 million people, did not have health insurance at any point during the year,” according to the United States Census Bureau.

The burden of care coordination is an issue of health equity, and it must be addressed for the social good industry to evolve. HealthEquityGuide.org, A Human Impact Partners Project, defines health equity as, “everyone ha[ving] a fair and just opportunity to be as healthy as possible. To achieve this, we must remove obstacles to health—such as poverty, discrimination, and deep power imbalances—and their consequences, including lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”

System Failure 3: The system is drowning in manual administrative labor, but few providers have the resources or support to embrace smart technology.

The industry has a long-held bias against operational investments, limiting capacity and innovation. Analysis published in Pacific Standard reveals that “many medical social workers find themselves spending two hours on filling out forms for every one hour they deal with a face-to-face engagement with one of their clients.” In fact, administrative overload is such a widespread problem in the sector that, as the Social Work Degree Guide laments, “Because of this increased emphasis on paperwork, social workers are leaving their field, despite wanting to make a difference in the lives of their clients.”

Getting bogged down in paperwork no longer has to be the norm. The healthcare industry recently embraced digital transformation—namely, the Electronic Patient Portal—with positive impacts for practitioners and patients alike. Making it far more efficient to enter and track electronic health records gives individuals unprecedented access to their own health data—and more control over their personal health.

System Failure 4: Funding is tied to data and analytics, but the system makes accurate and standardized measurement impossible.

Tracking data and reporting impact are notoriously difficult in the social good space. As a recent Data Standardization study published in the NYU Law Review explains, “Absent data standardization, a ‘Tower of Babel’ of different databases may be created, limiting synergetic knowledge production.” Just as the private sector has relied on technology (like customer relationship management software with advanced analytics) to grow their businesses, our industry must embrace codified data infrastructure and automated reporting driven by artificial intelligence (AI) to increase our knowledge, efficiency, impact, and funding.

 

A Sector-Wide Win-Win

Comprehensive community care eradicates these system failures, improving user and other stakeholder experiences in the social good space. Let’s consider the current circumstances stakeholders face relative to the difference comprehensive community care can make.

Before Comprehensive Community Care	After Comprehensive Community Care
Program Participants
In spite of dealing with multiple compounding factors, service seekers are expected to be aware of the services available to them and manage getting care in a self-directed manner.	Service seekers gain access to a trusted network from a single point of entry; they only have to tell their story once and can be referred easily to all the services they need. They retain access to and control over their information, experience increased agency, and spend less time navigating the system and more time getting the services they need.
Organization Staff
Case workers are overwhelmed by their case volumes and the accompanying manual, clerical work. They are frustrated by the difficulty coordinating care with other agencies and communicating with service seekers and by the inability to serve more people effectively.	Case workers dramatically reduce their administrative labor and are able to fast-track program participants through digital referrals in a vetted network of trusted providers. They have unprecedented visibility into the full scope of services, activities, and progress of program participants and can more easily communicate with them.
Executive Boards
Board members rarely have the data they need to properly illustrate outcomes; disparate information sources make it impossible to tell compelling community impact stories.	Board members can track and measure organizational impact over time and demonstrate value to funders with standardized data that enables powerful analytics—garnering more support to advance their mission.
Funders
Funders want to know they’re making good investments and see the impact of their support. They expect numbers to show real outcomes that connect stories to quantifiable impact and may overlook organizations unable to provide this level of detail.	Funders see detailed program analysis that shows dollars at work. With a better understanding of impact and the ability to see progress over time, funders are compelled to maintain and increase their support for organizations they may have otherwise overlooked.
Communities
The inability to access social good services creates an ongoing loop of reduced life quality for individuals and families that is apparent at the community level.	A more efficient and accessible system for delivering social good services ultimately creates healthier and more productive and equitable communities.

 

In sum, our ability to achieve real impact in our communities moving forward will depend on how the social good industry embraces technology, shares resources and information, and collaborates to care for individuals as whole humans with complex and interrelated needs.

The Kaiser Family Foundation report on Disparities in Health and Health Care reminds us that, “Addressing disparities in health and health care is important not only from a social justice and equity standpoint, but also for improving the nation’s overall health and economic prosperity. People of color and other underserved groups experience higher rates of illness and death across a wide range of health conditions, limiting the overall health of the nation.” These disparities are costly, too, accounting for 93 billion dollars in excess medical care costs and 42 billion dollars in lost productivity per year.

Comprehensive community care can help our industry collaborate efficiently and empower participants to take control of their health journey so that we reach greater levels of health and social equity. Such an approach can connect data across organizations, making reporting more impactful and, ultimately, making it easier for funders to identify organizations driving outcomes that lead to impact.

Perhaps, with such changes, we’ll one day see a hit series about a young mother who triumphs over abuse and poverty with the help of a connected network of providers working efficiently and collaboratively to support her success.