Complex Care Ecosystems in the Wake of COVID-19

Feb. 12, 2021
Whose responsibility is it to take the lead and begin creating complex care ecosystems within the communities that need it the most?

Establishing complex care ecosystems in communities hardest hit by COVID-19 can mean the difference between life and death. But who should be responsible for developing these critical models of care?

Communities nationwide continue to battle increased unemployment as well as chronic physical and mental illnesses exacerbated by the effects of a still-raging pandemic. The confluence of negative social, economic, and health factors have proven deadly, but nowhere has it been felt as strongly as in communities which have been historically disenfranchised or other similarly vulnerable populations.

Recent studies have shown that a comprehensive healthcare ecosystem can be highly effective in not only treating care outcomes, but also the root causes which contribute to any disparities. But with a healthcare system that is already under tremendous pressure due to COVID-19, essential community resources are more overburdened and siloed than ever. So, whose responsibility is it to take the lead and begin creating complex care ecosystems within these communities that need it the most?

The answer to this question is not straightforward, and it would depend upon the community and the engagement of key stakeholders.  The development of an effective health ecosystem is a complicated undertaking which requires trust, communication, and clear alignment of objectives. 

Kathleen Noonan, Chief Executive Officer of the Camden Coalition of Healthcare Providers, a nonprofit healthcare innovator, describes their approach, “We’ve been running the Camden Coalition’s National Center for Complex Health and Social Needs for over five years and have learned from working with communities across the country that people are served better when the agencies and providers who take care of them have a shared vision and regular channels for communication at the client and system levels.”

Prior to the pandemic, issues within the healthcare system and the societal factors which affect care outcomes were at the forefront of the complex care discussion. The advent of the COVID-19 crisis has now caused these issues to increase tenfold. A survey conducted by the Commonwealth Fund revealed the inequities by race, ethnicity, and income level that have been exacerbated by the pandemic. In addition to the increased financial hardships in Black and Latino communities which negatively impact their social determinants of health, areas with larger Black populations tend to have a higher percentage of COVID-19 infections and deaths than others. In regards to mental health, 44 percent of individuals with lower income reported mental health concerns, compared to the 26 percent of individuals with above-average income. The Black and Latino respondents also reported mental health concerns related to the pandemic at a rate 10 points higher than the white respondents.

The reality of this rapid acceleration of negative trends has once again prioritized discussions related to the complex care ecosystem, as well as the importance of a community-based approach.

A clear case can be made for hospital systems serving as the lead conveners for a community-focused complex care ecosystem.  Hospitals tend to have multiple levels of care, and systems of support which include care coordination, referral management, and ambulatory care. Their well-established systems and substantial resources can serve as a solid foundation upon which to build.  Additionally, proactively managing the care of high utilizers who may be contributing to unnecessary emergency room usage would benefit the hospitals from an operations and cost perspective.  However, many rural communities may not have easy access to a local hospital which could serve as the launching component of a solid ecosystem.  Also, hospitals are more financially and operationally burdened now more than ever due to COVID-19. 

Another option to spearhead the development of a community’s complex care ecosystem is a Community-Based Organization (CBO), especially one already providing social services supports or mental health care. These organizations are ideal because they typically have a broad network of existing partnerships in order to effectively coordinate care, and they are well-established within the communities they serve.  Though many CBO’s may not have the breadth of internal resources available to hospital systems, they have the ability to engage with the community in a culturally relevant way to address the social determinants of health. A well-planned CBO-led approach can result in an effective ecosystem for their community by the formalization of many of its existing relationships and establishment of clear communication and coordination plans. 

Clearly, COVID-19 has not only exacerbated existing societal issues which contribute to poor health outcomes, but it has placed pressure on the healthcare system not seen before in modern times. So, regardless of who fills in the leadership vacuum and establishes these essential ecosystems for vulnerable communities, it is apparent that innovative approaches to care-driven partnerships are more important now than ever.  

Melissa Fox is the Chief Operating Officer at Acenda Health

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