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Unique impacts of the COVID-19 pandemic on individuals with complex health and social needs
The spread of COVID-19 in the United States and globally has made stark what we in the complex care field already knew: our fragmented care systems and frail safety net leave our most vulnerable community members at heightened risk, especially during times of national emergency. Individuals with complex health and social needs are particularly vulnerable […]...Read more
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Using social needs screening and patient feedback for complex care
Understanding a patient’s social complexities is essential to support holistic clinical care, clinical quality improvement, and tailored care interventions. However, complex care programs may find it difficult to incorporate these factors into standard risk stratification methods. They may also face distrust from patients who have historically been poorly served or harmed by healthcare institutions. This […]...Read more
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ICD-10-CM coding for social determinants of health
This fact sheet from the American Hospital Association introduces the ICD-10-CM “Z codes” that allow hospitals and other health settings to capture data on the social needs of their patient populations. Despite the availability and utility of these ICD-10-CM codes, hospitals have not widely adopted the use of Z codes. The fact sheet provides clarity […]...Read more
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Organizational-level consumer engagement: What it takes
This report and series of case studies from the Center for Consumer Engagement in Health Innovation and the Health Care Transformation Task Force looks at how three organizations meaningfully engage patients, families, and caregivers to improve care. The case studies on Children’s Mercy Kansas City, Hudson River Health Care, and Trinity Health examine: The array of […]...Read more
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Recognizing and sustaining the value of community health workers and promotores
This brief from the Center for Health Care Strategies (CHCS) explores how lay health workers — individuals with lived experience who are hired to support patient needs — are playing a key role in the health care system, in California and around the country. It highlights examples of the value that community health workers and […]...Read more
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Virtual site visits for population health changemakers
This video series from the Center for Care Innovations takes viewers on a set of “virtual site visits” to organizations around the country with innovative programs for population health management. The series highlights: Chapa-De Indian Health, which introduced a new scheduling method that improved care Santa Barbara Neighborhood Clinics, which integrated registered nurses as panel […]...Read more
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Engaging patients and community members in trauma-informed care implementation planning
This fact sheet from the Center for Health Care Strategies (CHCS) outlines considerations to guide health care organizations in meaningfully engaging patients and community members around designing and implementing a trauma-informed approach to care. Key considerations include: Incorporate patient and community member feedback early in the process Create a variety of outlets to solicit feedback […]...Read more
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Five strategies to expand palliative care in safety-net populations
Safety net providers serve a substantial percentage of low-income individuals in the United States, many of whom have complex health and social needs including trauma, behavioral health conditions, and social determinant factors. As these individuals face serious medical illnesses and become eligible for palliative care, they may find that their care is misaligned with their […]...Read more
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Trauma-informed approaches in clinic and community settings
The significance of trauma has become an increasingly accepted tenet of complex care. While there is general agreement on the core principles of trauma-informed care and that trauma can negatively impact an individual’s health and wellbeing, there are many ways to apply a trauma-informed approach in different settings. Presenters Katy Davis from the University of […]...Read more
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Healthcare hotspotting: A randomized, controlled trial
The Camden Core Model is the Camden Coalition of Healthcare Providers’ signature care management intervention. From 2014-2017, the Camden Coalition (which houses the National Center) partnered with researchers affiliated with J-PAL North America to conduct a randomized controlled trial (RCT) that would help us learn more about how our model affects patients’ hospital readmissions. The […]...Read more
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Office Hours: Open call for approaches supporting individuals with alcohol use disorder and other complex needs
Substance use disorder has received increased public attention due to rising rates of opioid-related overdose deaths and misuse of prescription opioids. While opioid use disorder is an important issue, alcohol use disorder can also be a significant contributor to individuals’ complex health and social needs, due in no small part to alcohol’s legal status, social […]...Read more
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Putting Care at the Center 2019: Workshop resources
Find all available resources from Putting Care at the Center 2019 workshops here. Not seeing your resources or want to add additional resources? Email meetings.admin@horizonmeetings.com. Workshop: Addressing social complexity: Lessons for adult health from pediatric screening and performance quality measurement Facilitators: Kathleen Noonan, Simon Hambidge, Holly Henry, Mia Matthews, Colleen Reuland Organizations: Camden Coalition of […]...Read more
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Preventing adverse childhood experiences (ACEs): Leveraging the best available evidence
This report from the Centers for Disease Control and Prevention (CDC) provides an overview of how adverse childhood experiences (ACEs) impact health and opportunity, and lays out a series of strategies to prevent ACEs. These strategies include: Strengthening economic supports to families Promoting social norms that protect against violence and adversity Ensuring a strong start […]...Read more
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Building to a sum greater than its parts: A hands-on guide to cultural integration in community health partnerships and alliances
This guidebook from the California Health Care Foundation (CHCF) aims to help community health organizations mitigate cultural risks associated with partnering while simultaneously harnessing cultural strengths to build sturdier, more effective partnerships. Tools in the guidebook include actionable insights, hands-on exercises, and real-world examples. Using the guidebook, readers will learn: How to define what culture […]...Read more
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From siloed systems to ecosystem: The evolution of the Camden Coalition’s complex care model
While discussions about the social determinants of health are featuring more prominently in the nation’s current health policy conversation, many organizations, like the Camden Coalition of Healthcare Providers, have been working for years to understand and address this intersection. In the spirit of reflection and continuous learning, we thought it was time to share the […]...Read more
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The state of the field of complex care: A message from the Field Coordinating Committee
This handout from the 2019 Putting Care at the Center conference introduces the new Field Coordinating Committee (FCC), launched in 2019 to oversee field-building activities taking place across the country, and highlights trends in complex care identified by the FCC, including: Widespread engagement by health systems and payers to meet social needs Recognition of consumer […]...Read more
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Upcoming National Center activities
This handout from the 2019 Putting Care at the Center conference outlines upcoming activities and opportunities from the National Center, including: The second round of regional convening applications opening January 15, 2020 The new Complex Care Resource Exchange LinkedIn group Upcoming virtual learning opportunities Upcoming complex care ecosystem tools and resources Download the one pager...Read more
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What matters most in driving cross-sector partnerships for complex populations
It is widely recognized that good outcomes for patients with complex care needs are achievable when health care providers work locally and in tandem with community, government, and other partners. Interprofessional, cross-sector, and cross-agency collaboration between organizations that share responsibility for serving a group of individuals living in a community or particular geography is an […]...Read more
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Cross-sector collaboration for vulnerable population reduces utilization and strengthens community partnerships
Adventist Health Clear Lake, a critical access hospital serving Lake County, CA, and the surrounding areas, provides medical care to people with complex needs. Its patients’ social needs often manifest in clinical settings, prompting Adventist Health to pursue creative solutions to community issues. This led to the development of Project Restoration, a cross-sector intervention designed […]...Read more
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Screening for social needs: Guiding care teams to engage patients
This tool from the American Hospital Association is designed to help hospitals and health systems facilitate sensitive conversations with patients about their nonmedical needs that may be a barrier to good health. It includes strategic considerations for implementing a screening program, tips for tailoring screenings to hospitals’ unique communities, case examples and a list of […]...Read more
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Addressing the social needs of older adults: A practical guide to implementing a screening and referral program in clinical settings
This guide from West Health Institute and the University of California, Irvine details how to implement a social needs screening and referral program for older patients into clinical practice. It is intended for primary care providers serving older patients, but can also be applied to other clinical settings such as emergency departments. The interactive guide […]...Read more
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Advancing primary care innovation in Medicaid managed care: A toolkit for states
This toolkit from the Center for Health Care Strategies (CHCS) is designed to help state Medicaid agencies leverage their managed care purchasing authority to advance primary care innovation. The content is based on the experience of states participating in CHCS’ Advancing Primary Care Innovation in Medicaid Managed Care learning collaborative, and outlines design considerations and shares sample […]...Read more
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Medications for addiction treatment: Providing best practice care in a primary care clinic
This best practices toolkit, published by the Camden Coalition’s National Center for Complex Health and Social Needs and co-authored by Shelly Virva (Camden Coalition of Healthcare Providers) and Grace “Katie” Bell (Telewell Indian Health MAT Project), is intended for for program administrators and clinical care teams who want to establish effective medications for addiction treatment […]...Read more
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Integrating social care into the delivery of health care: Moving upstream to improve the nation’s health
A consensus study report from the National Academies of Science, Engineering, and Medicine (NASEM)’s Committee on Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation’s Health. The committee was convened by NASEM to examine the potential for integrating social care services into the delivery of health care with the ultimate […]...Read more
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A look at people who have persistently high spending on health care
This online brief from the Kaiser Family Foundation and Peterson Center on Healthcare’s Health System Tracker takes a closer look at the amounts and types of health spending for people with employer-based health insurance who have continuing high health care spending (for three consecutive years). The analysis includes data on what types of care people with persistently high spending are […]...Read more
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Rural communities (September-October 2019)
Rural areas present unique challenges and opportunities for individuals with complex needs and those providing their care. These environments may face healthcare workforce shortages, rising rates of opioid use, and geographical barriers to care. However, rural communities often foster close-knit social networks and an entrepreneurial approach to complex health and social issues....Read more
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Resource referral guide & template
This guide from Health Leads was developed from a workshop presentation at Putting Care at the Center 2018. The guide was created to help healthcare and community-based organizations create and maintain high-quality resource listings to address clients’ social needs, and includes the steps these organizations can take to better understand and proactively address barriers to […]...Read more
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Case study: Generalizability framework
This tool from the Abdul Latif Jameel Poverty Action Lab (J-PAL) North America was developed from a workshop presentation at Putting Care at the Center 2018. The resource introduces J-PAL’s “generalizability framework,” a practical approach for using evidence to assess whether a given program can be replicated or adapted to work in a new setting. […]...Read more
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Reducing health disparities: Strategies to support effective community health workers
This policy brief from the Penn Center for Community Health Workers, home of the IMPaCT community health worker (CHW) model, was developed from a workshop presentation at Putting Care at the Center 2018. The brief highlights financing and policy strategies – including value-based payments, program accreditation, and incentives to implement solutions correlated with high-quality programs […]...Read more
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Continuum case conferencing for an improved behavioral health system
This brief from Alameda County Care Connect and Bright Research Group details lessons and best practices learned from a pilot complex care intervention for high utilizers of psychiatric emergency services in Alameda County. The pilot convened monthly case conferences with a diverse group of providers from the psychiatric emergency system, County Health Care Service Agency, […]...Read more
Events & Webinars
Putting Care at the Center 2020
Start date: October 28, 2020
End date: October 30, 2020
Conference
Recent News
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Complex care in the time of COVID-19
By Mark Humowiecki, Senior Director, Camden Coalition’s National Center for Complex Health and Socia...
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New complex care startup toolkit: Request for resources
By Rebecca Koppel, Program Manager for Field Building & Resources We know from our local experie...
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Take the survey on core competencies for complex care
Since the Blueprint for Complex Care was released in December 2018, the National Center has been col...
The National Center for Complex Health and Social Needs is an initiative of the Camden Coalition.