BUSINESS ACUMEN CASE STUDY

Building the Western New York 

Integrated Care Collaborative

Submitted by Diane Oyler, PhD

Program Officer, Health Foundation for Western & Central New York

About the Network

The Western New York Integrated Care Collaborative (WNYICC) is a 

group of aging network providers who have been working together 

to make the most of emerging opportunities. It is composed of two 

county-based Area Agencies on Aging (AAAs), a local United Way, 

several nonprofit community-based organizations (CBOs) operating at 

the neighborhood (sub-county) level, and a small number of regional 

CBOs. Most have been a part of the Erie Niagara aging network for 

decades and provide core Older American Act services including case 

management, social adult day care, home-delivered meals, personal care 

services, and traditional senior center programs such as congregate 

meals. Although this group of providers believes they have a valuable 

role to play in turning the curve on healthcare and long term care 

spending, they recognize that there are considerable obstacles to 

participating in the evolving marketplace as stand-alone organizations. 

Obstacles in New York State

Although the densely populated “Big Apple” usually comes to mind 

when people think of New York, much of the state is rural. It is made 

of small towns and a handful of mid-size cities dotting Interstate 

90. Given its geography, the state has traditionally relied on county 

agencies for the delivery of aging and disability services, including 

both Older Americans Act services and Medicaid-funded long term 

services and supports (LTSS). These services have been delivered 

through networks of neighborhood-based CBOs in partnership with 

county governments.

Although county-level service delivery networks are still the norm and 

heavily relied upon in New York, emerging opportunities in the health 

ACL Business 

Acumen Initiative

To enhance the 

readiness of communitybased aging and 

disability organizations 

for contracting with 

integrated care 

entities, and prepare 

them for partnering to 

develop and implement 

integrated care systems, 

the Administration for 

Community Living (ACL) 

established its Business 

Acumen Initiative. As 

part of this initiative, 

learning collaboratives of 

well-organized networks 

of aging and disability 

organizations received 

technical assistance in 

marketing, contracting, 

service pricing, and 

other business areas. 

In addition, members 

of each collaborative 

shared relevant 

experiences, lessons 

learned, innovative 

ideas, and best practices 

for providing integrated 

care in a variety of 

community settings. 

Case studies such 

as this further ACL’s 

aim to share models 

and information with 

communities and local 

agencies facing similar 

challenges.

ACL.gov ACL is an operating division of the U.S. Department of Health and Human Services.
and human services marketplace increasingly 

require greater geographic reach. Medicare 

Advantage plans, Medicaid Long Term Care 

plans, and New York’s newly created Delivery 

System Reform Incentive Payment (DSRIP) 

Performing Provider Systems (PPS), are 

all responsible for health outcomes across 

multi-county regions and they need partners 

that can deliver services across those 

regions. Even state agencies, such as the 

NY State Department of Health and the NY 

State Office for the Aging, are increasingly 

opting to work with statewide and regional 

organizations rather than defaulting to 

traditional county-level partners. To appeal 

to both new buyers and traditional funders, 

aging and disability services providers must 

be able to offer programs and services that 

are consistently available throughout regional 

coverage areas. Limited geographic reach is 

quickly becoming the number one obstacle 

to working in the evolving healthcare 

marketplace. It can serve as an elimination 

factor for competing for new contracts.

Given the increased emphasis on regional 

service delivery systems, an integrated care 

network that brings agencies together from 

across Western New York can yield several 

benefits to traditional county-based AAAs and 

CBOs. The question has been how to proceed 

toward that end. To respond to immediate 

opportunities, WNYICC has been relying on 

its loosely affiliated structure. It has afforded 

WNYICC some success, including a five-year 

contract with the NY Department of Health to 

provide caregiver services to families affected 

by Alzheimer’s Disease. However, securing 

this contract was only possible because 

the funding opportunity allowed “a group of 

existing partners” to apply. That will not always 

be the case. To be well-positioned for future 

opportunities, a more formal network structure 

is needed. 

Building an Integrated Care 

Network

Networks can be organized in several 

ways, and organizers must take community 

readiness into account if their efforts are 

going to be successful. With the assistance 

of the Health Foundation for Western and 

Central New York, WNYICC explored how 

integrated care networks can best be 

organized to meet both organizational needs 

and community readiness in western New 

York. After that work, WNYICC determined 

that there were three features we would need 

in an integrated care network—regional reach, 

low set-up and organizational costs, and the 

ability to evolve along with the work. 

It was clear that integrated care networks 

can provide the geographic reach needed to 

apply for regional grants, seek accreditation 

for programs, and join Medicare Advantage 

provider networks. At the same time, we 

recognized that, while valuable, this initial work 

would need to be done on a shoestring budget 

so that partners have the ability to realize true 

gains from participation. Otherwise, individual 

providers may not see the value in the network 

and opt to “go it alone.” 

ACL.gov ACL is an operating division of the U.S. Department of Health and Human Services.
Beyond cost and reach, it was also important 

to build a network that would eventually be 

able to offer a range of services to members 

to demonstrate and articulate their value 

to potential new partners, including those 

working under value-based payment systems, 

where patient outcomes matter most. As 

WNYICC progressed through the learning 

phase of its efforts, we took the opportunity to 

talk to others in the community who had done 

similar network building work among health 

care providers. Those conversations pointed 

to the success of employing incremental 

strategies to network development. For 

instance, a group of primary care providers 

known as the Safety Net Association of 

Primary Care Affiliated Providers of WNY 

(SNAPCAP) described their collaborative 

efforts—which spanned several years—as 

evolving from what organizers describe as a 

“coffee club” to a Limited Liability Corporation 

(LLC), before finally going on to become a 

501(c)(3). 

The question for WNYICC was how to go 

about doing that during several months rather 

than several years. Did we need a 501(c)(3) 

to reach our immediate goals, which would 

be a time-consuming undertaking, or could 

we set up a LLC, which can be done in as 

little as a couple of weeks? What were the 

responsibilities, obligations, and potential 

obstacles? And how would a proposed venture 

be met by the governance bodies of potential 

partners? It was clear that we wanted 

something expedient, and needed something 

that was relatively easy to understand for 

both public sector principals, and nonprofit 

board members. 

A Solution Made to Grow

To address these questions and concerns, 

WNYICC met with an attorney that assisted 

several local collaborations, including 

SNAPCAP, to form network organizations. 

The attorney presented several options along 

with their advantages and disadvantages, 

and there was one alternative that clearly 

met our needs—forming a taxable nonprofit 

corporation. A taxable nonprofit had several 

advantages over alternative arrangements 

for WNYICC. First, it passed the speed test. 

Taxable nonprofits can be established as 

quickly as an LLC, while providing many of 

the benefits of the 501(c)(3). Moreover, 

the statutory law concerning these legal 

structures is well-defined, and can be used 

in lieu of organizational by-laws. This allows 

the structure to be operational while by-laws 

are being created—a plus as the network 

negotiates the questions that will surface as 

it evolves from a loose coalition to one that 

is more fully integrated. Although taxable 

nonprofits have tax obligations, those can be 

expected to be minimal as long as incoming 

revenue is used to compensate member 

agencies for services performed, and fund 

balances are kept at a near break-even point. 

While all these features made the taxable 

nonprofit attractive, the deciding factor was 

its ability to be converted into a 501(c)(3) at a 

later date when needed. This option provides 

ACL.gov ACL is an operating division of the U.S. Department of Health and Human Services.
a legal vehicle for implementing a network 

quickly, while giving us the ability to modify 

the structure as we grow. 

WNYICC worked with this attorney on 

securing a Certificate of Incorporation to 

communicate the value and appropriateness 

of the corporation to the governing bodies 

of partners. The attorney has also been able 

to point to similar efforts that have been 

undertaken in western New York by county 

public health departments and other publicprivate partnerships that are underway in the 

health and behavioral health fields. Securing 

the right legal expertise has been pivotal, as 

has been taking the time to research and 

report on system constraints that a network 

can help alleviate. The combination has helped 

us to make the case that such a network 

will help fulfill the AAA mission of planning, 

coordinating, and expanding services for 

the elderly, and that similar strategies have 

worked elsewhere. 

To learn more about business acumen and find tools to get started, visit the Aging and Disability

Business Institute and the Disability Network Business Acumen Resource Center.

ACL.gov ACL is an operating division of the U.S. Department of Health and Human Services.