The 2-1-1 San Diego Community Information Exchange (CIE) is a pioneer in connecting community-based organizations and health systems. Now, with 2-1-1 San Diego’s support, the CIE movement is spreading to other regions. For instance, HealthierHere is launching a CIE in King County, Wash., following up on its work in the Accountable Communities of Health program.
San Diego’s CIE platform shares client-level data and has participating organizations use a common risk rating tool. The CIE also facilitates community case planning, and care team communications to better address the social determinants of health.
The HealthierHere team spoke about the governance model under development for the CIE during a recent webinar put on by the Office of the National Coordinator for Health Information Technology’s (ONC) Social Determinants of Health (SDOH) Information Exchange Learning Forum.
Gina Morgan, chief operating officer at HealthierHere, said the organization has evolved and developed its governance model based on its local context. HealthierHere is a nonprofit multi-sector collaborative based in King County, Wash., where the City of Seattle is located. Its network includes more than 150 diverse organizations that have joined together with a common goal of eliminating health disparities, and improving the health and well-being of all people in the region.
“Our network is comprised of a broad array of community-based organizations, behavioral health providers, hospitals and health systems, federally qualified health centers, social service agencies, tribal organizations, managed care organizations, government foundations and funders,” Morgan said. “It is broad and inclusive by intent.”
Morgan noted that despite the economic vitality of the Seattle region, lower-income residents have been pushed out of the urban core, where the greatest concentration of resources exist, including jobs, supports and services. “Systemic barriers and racism make it difficult for people to get the help they need. There are 39 counties in Washington State, yet King County is home to almost a quarter of the state's Medicaid beneficiaries. We are resource-rich, but we are connection-poor. It is into this regional context that our network came together in 2017 to form a new nonprofit multisector, collaborative, HealthierHere, dedicated to improving the health and well-being of those who experience inequity and racism in the health and social systems, through community- and tribal-driven solutions that reflect and respect their needs, their lived experiences and their culture. It is in this regional context that we have become a hub to empower collective action, where we leverage our network and our resources to tackle complex challenges that no one organization or sector can solve on their own.”
It is from these origins that the path to a community-driven community information exchange has evolved, Morgan said. Conversations about growing disparities in King County had been happening for years. Health and human service providers together with county government had identified the need for the region's health and social care systems to change.
Washington State implemented an 1115 Medicaid waiver through the Center for Medicare and Medicaid Services in 2017, and HealthierHere was formed as the region's Accountable Community of Health. The effort provided needed infrastructure and funding to support what had been ideas and concepts and desires in the region. “This infrastructure has helped us to develop the shared governance model that formed the backbone of our Accountable Community of Health,” Morgan said. “This network of diverse stakeholders has also come together to develop relationships with one another, and trust building, as HealthierHere serves a role as a regional convener to address a multitude of issues affecting health and disparities in our region.”
The need for a community information exchange was identified with learnings from what was going on in San Diego County. HealthierHere was launched in 2017, and the need for a social determinant information exchange was identified. “In our region, we had multiple care coordination systems, referral technologies and platforms, and we really used the first couple of years to identify those systems,” Morgan said. “We started talking with the folks in San Diego to understand what they had done in their region, their model, their toolkit for developing community-driven community information exchange. It really was about aligning resources and planning together.”
“In 2020, after the shock of the COVID pandemic, our community told us if we'd only had an SDOH information exchange in our region prior to that pandemic, we would have been able to weather the storm a little more effectively in our ability to collaborate with one another,” Morgan said, so midway through 2020 is when the building of our community information exchange began to happen. Planning began in earnest with the launch of our Connected Community network after the initial shock of the pandemic. We expect that what we have embarked on as a community will be a longer-term effort. I'd have to say that this is also one of the key learnings here. Check your assumptions about pre-conceived timelines, because this work progresses at the speed of trust — trusting relationships between partners, between community organizations, between healthcare providers, social care providers, and our community. That is how this work has progressed. And it takes time to build those relationships.
The Connected Community network brings organizations together to coordinate care and services, so that no matter where an individual enters the system, they get connected to the right care in the right setting at the right time, Morgan said.
One of the core principles of this notion is a unified network across all health and human service organizations, she added. “The network would need to have both universal access and interoperability between existing networks and multiple technology platforms. This is critical in our region, which, as I mentioned, is resource-rich connection-poor. Equally important is the need to be locally owned and managed collaboratively by the community, not by one organization, platform or group — similar to a public utility. We see this as the need to be governed by and to serve the needs of the entire community, especially the needs of our community's most vulnerable.”
Sara Standish, associate director of community information exchange for HealthierHere, spoke about developing the governance structure. “Governance is critical because input from clinical, tribal, and community partners as well as community members inform all the other aspects of our work, including community and consumer engagement technology, and equity-centered data practices,” she said.
“Our governance work doesn't just focus on who's making the decision, but also who has input, who's providing feedback, who's making recommendations and how voices are elevated in the work that we're doing together,” Standish said. “We have designed a community-led governance structure. We often think about who's at the table and who's not. Are the structures set up that enable participation in an equitable way, and how our community members engaged? King County has strong tribes and indigenous-led CBOs. We knew it was important to be able to honor tribal data sovereignty. We've engaged tribal data sovereignty experts, and we've leaned on the expertise of HealthierHere’s indigenous nations committee to guide us.”
Standish also highlighted the importance of building relationships. “Our ability to do our work relies on the relationships both within and across sectors, and we hope that we're building a structure that will deepen those relationships, and enable ongoing co-creation of what the Connected Community network is. This work is iterative. Our ability to be in conversation with our clinical community, tribal partners and community members is critical for that. We're still very early in our CIE journey. While we've started this work, we continue to learn from others in the space, and I expect that our governance work will continue to evolve as we learn and grow.”