Integrated Health for Socially Complex People in Socially

Integrated Health for Socially Complex People in Socially Complex Neighborhoods Chairs: Kirsten Peachey John Bartlett Steve Tierney Michelle Tierney

World 1 to World 2 CEO interviews—point of stress for leaders is the movement from the current health environment (World 1) to the new health care environment (World 2) World 2 Area of focus for this work group— 1 st steps in moving into “World 2” World 1

3 areas where we need to focus further work of the Team n “Make the Case” n Don’t Wait to Innovate n Describe “The Way”

Make the case for treating the SDOH/Whole Person What is the true nature of the problem and the solutions? Grown-up eyes and thinking n Treat the whole person (including their context) and how that translates financially n In “World 2”, it makes sense to use Social Determinants of Health (SDOH) language and thinking n Practically—Data platforms, governance shifts, metrics n

Don’t Wait to Innovate n Don’t be slaves to processes/evidence base n Start with outcomes versus processes n Recognize and address anxieties n Specific models and examples

Describe “The Way” n What are practices that we know work/ that are “good” practices? E. g. Policy/Advocacy n Mutual engagement with community n Relationship building n CBPR (Community Based Participatory Research) n n Partnership Team collaboration

Areas for our Influence We also identified 3 areas where we feel the larger HSLG may use its influence to create a more ready environment for this work. This is longer term work— probably beyond the spring meeting with CEOs.

Areas for Our Influence federal partners 1. • • How can CMS reinforce this approach with concrete rewards for health systems that practice in this way? We need to be proactive voices to drive the ACO conversation

Areas for our Influence Data Infrastructure 2. • Nimble data platforms and systems with accessible and timely feedback for course correction

Areas for our Influence 3. Engagement with Denominational/ Religious Sponsors/Partners n n Partners in influencing governmental partners to reward community-based practice? Access theologies/values/principles that can guide and support role of health care systems as stewards of the community’s health.