LAUSR

BACKGROUND AND OBJECTIVES Partnerships between health care and social service organizations may contribute to lower health care use and spending. Such partnerships are increasing, including Area Agencies on Aging (AAAs) working and contracting with health care organizations. Nevertheless, knowledge about how AAAs establish and manage successful collaborations is limited. We sought to understand how AAAs establish and manage partnerships with health care organizations. RESEARCH DESIGN AND METHODS We conducted an explanatory sequential mixed-methods study using a positive deviance approach. We used national-level data to identify AAAs with multiple health care partners serving areas with low utilization of nursing homes by residents with low-care needs (n=9), and AAAs with few health care partners and high utilization for comparison (n=3). We conducted in-depth interviews with key informants from these 12 AAAs and their partner organizations (total n=130). A 5-person multidisciplinary team used the constant comparative method of analysis, supported by Atlas.ti software. RESULTS Highly-partnered AAAs were characterized by 3 distinctive features of organizational culture: 1) attention to external environments, 2) openness to innovation and change, and 3) risk taking to learn, improve and grow. AAAs and partners describe a broad set of organizational strategies and partnership development tactics, depending on their local contexts. These features were underdeveloped in AAAs with few health care partnerships. DISCUSSION AND IMPLICATIONS While federal and state policies can create more favorable environments for AAA-health care partnerships, AAAs can also work internally to foster an organizational culture that allows them to thrive in dynamic and challenging environments.