Butler and Nichols1 highlight the possibilities of coopetition (i.e., cooperative competition at interorganizational and intraorganizational levels) to fund the infrastructure of social determinants of health (SDoH). Although early examples showed success, coopetition poses possible risks to community-based organizations (CBOs) that offer SDoH services.
RISK 1: COST
A formal coopetition mechanism can be expensive and may impose above average functioning costs on participating organizations.2 Increased functioning costs may reduce the overall philanthropic efforts in CBOs outside the coopetition model. Thus, it is important to evaluate the total cost and total income at the CBO level before and after coopetition.
RISK 2: EQUITABLE FUNDING AND PURCHASING
Health plans possess tremendous financial power and can influence the purchasing decisions of other funders in coopetition. For instance, health plans are innately more interested in SDoH solutions that generate short-term, clear returns on investment for them (e.g., food) than in other solutions (e.g., home modifications, family caregiver support).3 It is possible that solutions with less return on investment evidence experience reduced funding. Tracking the funding status of services that are outside the coopetition model at a community level will offer a more comprehensive picture of coopetition’s impact.
RISK 3: AUTONOMY
Coopetition often requires a CBO network lead to negotiate on behalf of a group of CBOs. Although the CBO network lead plays an important role, some emerging evidence in coopetition shows that formal hierarchical structure has a negative effect on knowledge sharing, whereas informal lateral relations (e.g., social interactions) have a positive effect.4 In particular, a hierarchical model may unintentionally harm knowledge sharing and capacity building for small, minority-led organizations. Coopetition models should maximize autonomy and lateral interactions.
RISK 4: RESEARCH AND DEVELOPMENT
Radical innovation in SDoH is needed. One known advantage of coopetition is accelerating research and development. Yet coopetition in SDoH today still focuses too much on providing SDoH services and information exchanges, which may limit flexibility in research and development.5 Two practices may catalyze research and development. First, long-term SDoH coopetition is encouraged because coopetition that spans five to seven years is more likely to generate benefits related to increased innovation.2 Second, coopetition should treat CBO-led research and development as part of the infrastructure and allow flexible funding for such activities.
The US social care system is at a tipping point. Thoughtful coopetition that prioritizes structural, long-term benefits for CBOs warrants further research.
ACKNOWLEDGMENTS
The author would like to thank Julie Lawrence, Andrew Spencer, Aiden Wynia, and Dana Brittenham for sharing their expertise in public–private partnerships and community-based organization health care contracting.
CONFLICTS OF INTEREST
V. Wong is one of the founders of EVISET, a new venture aiming to improve structural equity in the field of social care.
REFERENCES
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