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System-wide strategies for re-housing in the COVID-19 era
Quarantine hotels/motels have been important models among health and community-based organizations working to protect individuals experiencing homeless or housing instability during the COVID-19 pandemic. The strategies and approaches in communities are now shifting from these urgent and temporary initiatives towards a comprehensive re-housing strategy....Read more
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Quarantine hotels: Promising practices and resources
Quarantine hotels/motels are a common approach among health and community-based organizations working to protect individuals experiencing homelessness or housing instability during the COVID-19 pandemic. While promising practices are beginning to emerge, these resources are incomplete. Programs that are newer to housing may not be aware of the resources that do exist or how to adapt them […]...Read more
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Insights from the social sector: A cross-sector response to health disparities in the COVID-19 pandemic
Cross-sector partnerships are more critical than ever as the COVID-19 pandemic threatens the health and broader social systems of communities across the country. This is especially dire for individuals with complex health and social needs who may already have difficulty accessing needed services....Read more
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Complex care and the COVID-19 pandemic in rural and frontier environments
Every community has been impacted by not only the COVID-19 pandemic itself, but also the pandemic’s effects on the economy and available resources. Rural and frontier environments across the country are not immune to these issues. The pandemic has exacerbated existing barriers to care for individuals with complex needs in these areas including physical distance, limited […]...Read more
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Racial disparities and disproportionality index
A data tool from CSH that measures whether a racial and/or ethnic group’s representation in a particular public system is proportionate to, over or below their representation in the overall population (proportionality) and also allows for the examination of systematic differences between groups and geographies (disparities). Distinguishing the Racial Disparities and Disproportionality Index (RDDI) from […]...Read more
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Measuring complexity: Moving toward standardized quality measures for the field of complex care
For the field of complex care to show its value in improving outcomes and to evaluate programs’ delivery and impact, there is a need to identify and standardize measures that are used for evaluation and quality improvement. One of the recommendations of the Blueprint for Complex Care was to develop standard quality measures for complex […]...Read more
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Immediate approaches for collaboration during the COVID-19 pandemic
On April 17, the National Center for Complex Health and Social Needs held the third convening of our community forum series on the impact of the COVID-19 pandemic on complex care. The conversation explored the ways in which this fragmented system is impeding care delivery for complex patients and identified near-term opportunities to address them […]...Read more
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Supporting complex care teams during the COVID-19 pandemic
On April 10, the National Center for Complex Health and Social Needs held a second community forum on unique issues facing complex care teams. Issues such as disruption of care delivery, staffing, and burnout were discussed. Once again, participants shared personal experiences and resources with their peers. The full list of resources is linked below. ...Read more
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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
Events & Webinars
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Recent News
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How people with complex health and social needs can become advocates for change
By Mia Matthews, President/Executive Director, CHANs Promise Foundation; 2019-2020 National Consumer...
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Addressing barriers to care in metro Atlanta
By Alex Lipira, Program Assistant for Field Building and Resources The Blueprint for Complex Care hi...
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Establishing complex care core competencies
By Mark Humowiecki, Senior Director, Camden Coalition’s National Center for Complex Health and Socia...
The National Center for Complex Health and Social Needs is an initiative of the Camden Coalition.