Social Determinants of Health (SDH) and Community Based Organizations (CBOs)

SDH are defined as the conditions in which people are born, live, grow, work, and age. These conditions can affect a wide range of health risks and outcomes. The five key domains of SDH include: economic stability, education, social and community context, health and health care, and, neighborhood and built environment. Integrating health and human services to address social care needs (SCN) can have a significant impact on health outcomes. Under Value Based Payment (VBP), VBP Contractors aim to realize savings while achieving quality outcomes by addressing SCN that drive healthcare cost and poor health outcomes.

The purpose of this page is to act as a resource of information for health systems and community-based organizations in relation to the VBP Roadmap requirements. Starting January 1, 2018, all VBP Level 2 and 3 arrangements MUST implement, at a minimum, one Social Care Need (SCN) intervention and contract with at least one community-based organization (CBO). Please feel free to email all questions about this requirement to the SDH team at To find out more about the Bureau of Social Care and Community Supports (BSCCS), please click here.

Resource: The Greater New York Hospital Association has updated their Health Information Tool for Empowerment (HITE) with updated information on social service organizations that are currently open to serve Medicaid members. There is a new temporary filter that allows organizations to be searched by operating status (on-site/regular operations, remote operations, pick-up, and delivery).


Delivery System Reform Incentive Payment (DSRIP) Program

DSRIP Performing Provider Systems (PPS)

Population Health Improvement Program

Medicaid Managed Care Organization Plan Directory

MLTC Plan Directory

VBP University

DRSIP Value Based Payment Resource Library

HEDIS Measures

First 1000 Days on Medicaid Proposals

Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs

CBO Planning Grantees- Please contact grantees for available administrative/ support services for CBOs.

Health and Welfare Council of Long Island - Long Island

Hudson Valley Collective for Community Wellness

Healthy Community Alliance - Rest of State
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