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Start here: EXAMPLE (pulled from advisor note below with additions by Addie and Hunter): Between health care agencies and housing/homeless CBOs: Pressure on CBO to adopt healthcare technologies and formats (HIPAA, EHR). Health care agencies assume that homelessness services don't have their own documentation standards, regulatory structures, etc. (HUD, HMIS) Impact: impasse. Another impact could be: CBO is forced to do what health care requires, and has to use additional labor and cost. 

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Start here: EXAMPLE (pulled from advisor note below with additions by Addie and Hunter): Between health care agencies and housing/homeless CBOs: Pressure on CBO to adopt healthcare technologies and formats (HIPAA, EHR). Health care agencies assume that homelessness services don't have their own documentation standards, regulatory structures, etc. (HUD, HMIS) Impact: impasse. Another impact could be: CBO is forced to do what health care requires, and has to use additional labor and cost. 

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In the case of CalAIM and MediCal, there are power dynamics of knowledge and familiarity which organizations who are new to Medi-Cal don't have e.g. contracting, regulations, MCP understanding.

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Service Delivery and Program Implementations

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Service Delivery and Program Implementations

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Community Based social services agency hold the power to the community and individuals.  They are the gate keepers with deep understanding of the dynamics of their community.  They have a stake in uplifting the community.

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Community Based social services agency hold the power to the community and individuals.  They are the gate keepers with deep understanding of the dynamics of their community.  They have a stake in uplifting the community.

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healthcare entities have lobbying and political power

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healthcare entities have lobbying and political power

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Building relationships with the community is a form of power

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Building relationships with the community is a form of power

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Relationships with state government can be imbalanced

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Relationships with state government can be imbalanced

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Knowledge of the community and the individuals being served

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Knowledge of the community and the individuals being served

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Outcomes are another way to garner power and expertise within organizational programs.

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Outcomes are another way to garner power and expertise within organizational programs.

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Sometimes the parties who are working together have data that their partners don't have access to that may impact their ability to do their work effectively.

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June advisor comment re impact: "understanding of respective priorities, values, perspectives and mission"

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June advisor comment re impact: "understanding of respective priorities, values, perspectives and mission"

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Often because shared understanding doesn't exist and these conversations don't happen, folks miss where they can build trust and transparency which then exacerbates power dynamics

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June advisor comment re impact: "Historical power imbalances needs to be taken into account, especially political power and privilege."

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June advisor comment re impact: "Historical power imbalances needs to be taken into account, especially political power and privilege."

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Physical space (facilities, size, geography, etc)

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Physical space (facilities, size, geography, etc)

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Personal connections in their respective fields

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Personal connections in their respective fields

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"and specifically staff with MediCal expertise"

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"and specifically staff with MediCal expertise"

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Power comes in different forms and successful social services programs that support equity have power.

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Power comes in different forms and successful social services programs that support equity have power.

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CBO whois in partnership with a hospital

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CBO whois in partnership with a hospital

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The timing of growth and scale differs for us vs our partner. We want to move more slowly and thoughtfully to ensure our sustainability, but this has been challenging as we feel pressure to move based on timelines defined by others.

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How to run harmonious teams as an effective leader - CCALAC

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How to run harmonious teams as an effective leader - CCALAC

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Funding allocations and security - CCALAC

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Funding allocations and security - CCALAC

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Being able to leverage the voices of the community -CCALAC

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Being able to leverage the voices of the community -CCALAC

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Number of member FQHCs served in LA County - CCALAC

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Number of member FQHCs served in LA County - CCALAC

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Health plans hold a significant amount of the funding available, so CBOs are somewhat necessarily beholden to the needs of the health plans. That said, the health plans know that in many cases the key to serving the community well is partnering with the organizations who are already engaged with our members, and often already providing the services that are reimbursable under CalAIM. There is definitely a significant knowledge gap and an infrastructure gap, though one that has been improving, for many CBOs to have the ability to contract with health plans. We have worked really hard to provide funding to bridge the infrastructure gap and participate in the county PATH meetings to bridge the knowledge gap, and I think that’s been fairly successful, though that success looks a little different county to county.