Peter Freeman, MPH
Public Health Strategist & Senior Advisor
On March 11, 2021, President Biden signed the American Rescue Plan Act of 2021 (H.R. 1319) (ARP) into law. The bill allows for $1.9 trillion in federal spending to help mitigate the continued effects of the COVID-19 pandemic. Expenditures covered by the bill related to many aspects of life in America, including housing, education, agriculture, transportation, and the environment.
As addressed in our previous article (“The American Rescue Plan and Public Health Infrastructure”) the ARP represents “big” legislation, but it also takes into account the needs of small businesses, allocating an estimated $50.95 billion, specifically to support small businesses. The U.S. Small Business Administration [SBA] provides a detailed breakdown of the various initiatives, but the purpose of this article is to spotlight a new pilot program, the Community Navigator Program (CNP). The CNP is a two-year pilot to support “underserved small businesses” with accessing federal funds available to address challenges and hardships resulting from the COVID-19 pandemic.
The pilot uses a “Hub and Spoke” model to establish regional “Hubs” around the country that organize networks of support, “Spokes,” for small businesses and entrepreneurs. “Hub” organizations are responsible for the appropriate administration of ARP funds and supporting “Spoke” organizations in their delivery of services. “Spoke” organizations will be trusted community-based entities (including government bodies, business associations, and other professionals) that commit to conducting outreach to small businesses and entrepreneurs that may need assistance in identifying, applying for, and appropriately utilizing federal financial assistance programs, as well as other recovery services (e.g., marketing, operations, and business development support). The CNP pilot focuses its support on “small businesses, including micro and rural businesses, with emphasis [on] those owned by women, veterans and socially and economically disadvantaged individuals.”
In addition to the “Hub and Spoke” business model (which is a model also used to help provide services to patients with Substance Use and Opioid Use Disorders), the CNP pilot also has design features similar to a Community Health Worker (CHW) program. With a CHW program, providers enlist the help of community members to engage patients in health-seeking behaviors. These patients are often managing multiple health conditions and may face significant barriers to accessing care. CHWs support patients given their familiarity with the communities in which patients live and generally reflect the demographics of patients providers are hoping to engage in care. In the CNP pilot, the CHW equivalents are the “Spoke” organizations and the individuals they enlist to outreach and provide direct support and technical assistance to small business owners and entrepreneurs.
The CNP pilot will run for two years, from September 2021 through August 2023 (and that is a hard deadline: the RFP explicitly states unexpended funds as of August 31, 2023, will be withdrawn). Given that there may be up to 100 “Hub” organizations supporting any combination of states, cities, regions, municipalities, and tribal and rural communities (all dependent on the tier of funding the “Hub” organizations applied for), variance in how “Hubs” and “Spokes” offer support is to be expected.
However, there are some best practices in network management, communication, and relationship building that apply across the board. While we can’t profile each “Hub and Spoke” system (though reach out to us if you want help understanding yours, specifically), we can share with you lessons learned from the deployment of “Hub and Spoke” operations in the healthcare field.
LESSONS 1: UNDERSTAND THE “HUB”
As a small business owner or entrepreneur, the person you will likely interact with most is a representative from a “Spoke” organization, called a “Navigator.” This individual (or individuals, potentially) should live in and be familiar with the geography in which you operate your business; there is also a likelihood that they have similar demographics as you (e.g., race, gender, veteran status). The purpose of the Navigators is to support you in miring through the red tape associated with accessing federal relief related to the COVID-19 pandemic, as well as using pilot program funds to engage in other recovery services, such as business development, marketing, and contracting assistance. In return for their services, you will be providing them, and therefore the “Spoke” and “Hub” organizations, with data regarding the services you received from the Navigator and outcomes resulting from the use of pilot funds.
In large part, the intent of Navigators and “Spoke” organizations is to develop outreach and engagement initiatives that most effectively reach target individuals and businesses in their specified geography. “Spoke” organizations will likely have significant latitude in the creativity they can deploy to achieve this goal. However, it is essential to remember that all “Spoke” organizations are under the oversight of a “Hub” entity, which is ultimately responsible for the legal use of pilot funding. There are directives and guidance the “Hub” can impose on its “Spoke” organizations. As with any top-down operation, we anticipate that some of these requirements may not be shared at the community level. While this could make sense in some instances, it may create frustrating roadblocks in others.
But that’s not so different from what happens in healthcare. Often, the systems set in place by an insurance company or provider do not seem to facilitate a patient receiving the services they need. As a result, patients are prevented from or actively choose not to access care. Enter the Community Health Worker. The role of the CHW is, among others, to help patients understand the healthcare systems they need to engage with to receive the full suite of services available to and necessary for them. When patients increase their understanding of the macro-level, they are better equipped to navigate the micro-level of accessing individual services effectively. A qualitative study of a 6-month CHW intervention found that by helping patients understand the systems at play, CHWs helped to “reduce anxiety,” “boost self-esteem,” and “improve the overall patient experience and health outcome” for the patients they worked with.
All of this to say: there is great potential for Navigators within the CNP pilot to be effective supports, but they must also understand that effectively navigating the local requires an understanding of the larger context. There may be ways in which your “Hub” organization is requiring its “Spokes” and Navigators to operate to remain compliant with the use of federal dollars. Given that the purpose of the CNP pilot is to help you, we believe an essential part of that support is in helping you understand how your “Hub” is operationalizing the pilot guidance.
LESSON 2: BE FORTHCOMING IN YOUR CHALLENGES
According to the CNP pilot RFP, “Spoke” organizations are to be “skilled in providing technical assistance to small businesses” and focused “on reaching or exceeding agreed-upon goals for participation in aid and technical assistance programs by underserved communities.” To fulfill these expectations, “Spoke” organizations will require an important thing from you, the small business owners, and the entrepreneurs they are supporting: truthful information. Part of the rationale behind the CNP pilot is the reality that small, under-resourced, and underserved businesses often face significant capital, resource, and other challenges to access services, even when explicitly deployed for their benefit. To help you address those challenges, however, Navigators must know what they are.
When working in companies with limited resources, it is a struggle to strike the right balance between identifying a need for help and showcasing a capability to be solvent should the help not be made available. This often results in either not asking for the full suite of support needed or overpromising the sustainability of goods and services without additional capital. But that is a balance to be made in front of the funder. It is important to remember that Navigators are not playing the role of the funder. Instead, their function is to help you prepare for the ask for the funder, be it the federal government or some other entity. In order to most effectively support you in accessing assistance funds and recovery services, Navigators must understand the specific challenges you are facing. One of the purposes of the “Hub and Spoke” model is to deploy community-based solutions to address community-specific challenges. Effective solutions cannot be developed if challenges are erroneously identified.
Clear identification of challenges specific to “Spoke” organizations is a lesson the Jefferson Medical College learned from its Jefferson Neuroscience Network (JNN) initiative. The JNN launched In 2010 to address strokes through a hub-and-spoke model of tele-based services. Based on their experience, the Jefferson Medical College identified three key components of effective hub-and-spoke relationships. One was the ability to “address Spoke-specific obstacles.” In doing so, JNN spokes were able to meet the needs of their patients and share lessons learned with the JNN hub, which was responsible for deploying learnings across all spokes.
The CNP pilot intends to address the individual needs of each small business owner and entrepreneur engaged in the program. By clearly, and honestly identifying the challenges you face, you are both helping to ensure your Navigator and “Spoke” organization are addressing your specific needs while also adding to the growing understanding of barriers experienced by small business owners and entrepreneurs when trying to access federal relief funds and recovery services.
LESSON 3: BUILD YOUR COMMUNITY
Much of the CNP program guidance focuses on the 1:1 outreach and engagement provided by “Spoke” organizations and Navigators to small business owners and entrepreneurs. There is no explicit requirement, for example, that a “Hub,” “Spoke,” or Navigator convene the individuals they are supporting to share challenges and identified solutions. Yes, we recognize that the Navigator is there to address your specific needs. But we also know that some of your particular needs will apply to others serviced by your “Spoke” organization.
Chances are you may be a member of or follow a local or state business association, so you know the importance of pulling together as a business community to understand current events and prepare for upcoming changes. We view the CNP pilot as another opportunity to build a community of local small business owners and entrepreneurs from which you can receive support. There is a possibility that “Hubs” and “Spokes” in the CNP pilot will convene businesses they are supporting. But in case they don’t, we recommend you leverage your relationship with your Navigator, “Spoke,” and “Hub” (which will hopefully be a strong one if you act on Lessons 1 and 2) to ask for opportunities to convene with others participating in the program.
A MODEL THAT APPLIES BEYOND COVID-19
The Community Navigator Program is designed specifically to help small business owners and entrepreneurs more effectively weather the challenges resulting from the COVID-19 pandemic. Data will be collected on how the pilot was deployed and the outcomes associated with this specific use of federal dollars. Likely, these data will primarily be used to defend the use of ARP funds for the CNP pilot. But we also hope the data will help the Biden-Harris and future administrations formulate new ways to provide ongoing support and technical assistance to the small business and entrepreneurial infrastructure of the United States.