The CIE San Diego model was recently highlighted in the Blue Shield of California Foundation sponsored report, “Opportunities for Whole Person Care in California,” Prepared by John Snow, Inc., In collaboration with the California Association of Public Hospitals and Health Systems, and the California Health Care Safety Net Institute.
John Snow, Inc. (JSI) is a public health research and consulting organization with a focus on vulnerable populations. We prepared this White Paper with the generous support of Blue Shield of California Foundation and in collaboration with the California Association of Public Hospitals and Health Systems (CAPH) and the California Health Care Safety Net Institute (SNI).
As a non-profit trade organization representing California’s public health care systems, CAPH works to strengthen the capacity of its member health care systems to advance community health; ensure access to comprehensive, high quality, culturally sensitive health care services for all Californians; and educate the next generation of health care professionals. SNI is the quality improvement, transformation and research partner of CAPH, designing and directing programs that accelerate the spread of innovative practices among California’s public hospitals, public clinics and beyond.
Low-income, vulnerable individuals often have unmet health service and behavioral health needs; furthermore, these individuals often experience challenging social and economic issues, such as housing instability, unemployment, and food insecurity, that can cause, exacerbate, and complicate the treatment of health conditions, leading to unfair and avoidable differences in health status.1,2 When health issues then arise, it is often in a fragmented, fee-for-service health system that can be difficult to navigate, and which does not consistently coordinate with the behavioral health system and social services systems that may be serving the same individuals. While the need to better coordinate services has been long recognized, progress has been challenging due in part to the fragmented nature of the organizational structures and financing of our current healthcare and human services systems. The result is that vulnerable individuals who have the greatest health, behavioral health, and social service needs often find themselves having to navigate systems that have different structures and practices, programmatic goals and financial incentives.
In order to achieve the Triple Aim3 of improving health outcomes, reducing per capita costs and improving patient experience within the safety net, it will be necessary to employ new philosophies and practices. Part of the solution lies in improved coordination of care within and across systems. It is also necessary to better account for and address the conditions that shape health in the environments where people live, work, and play.4 These conditions are frequently referred to as the “social determinants of health,” and addressing them has often been considered the purview of policymakers and non-health sectors (e.g., housing, economic development, education). However, there is increasing interest and attention focused on the potential to address social determinants in a clinical context at the individual and service system levels while policy efforts continue at the community level.5 In a prior paper, written as part of this Blue Shield of California Foundation (BSCF) project, we proposed a “whole-person care” framework to approach the challenge of addressing vulnerable individuals’ health, behavioral health, and social needs in concert rather than in isolation.
“While all counties reported having some systems that allowed for limited levels of interface and transfer of data, San Diego County notably articulated a vision for building a system that would allow interface between data in the health information exchange, county information systems, and a community-based services information exchange.” (p. 29)
The complete report is available here: