CommonSpirit Health is working with many other organizations to build networks of health care and social services that increase access to community resources for any patient in need. We call this model the Connected Community Network (CCN).
A CCN is a network of community service organizations that have the ability to make referrals using a shared technology platform among hospitals, clinics, and the social service and government agencies that provide vital services. These resources meet a variety of social and economic needs, including stable and affordable housing; maternal, infant, and child health; chronic disease management programs; healthy food; and mental health and substance abuse counseling.
The Total Health Roadmap helps us understand and address the impact of social determinants of health in order to provide equitable, effective, and high-quality health care.
Within pioneer communities in Colorado, Iowa, Kentucky, and Minnesota, we have developed a model for universal screening for social needs and the integration of community health workers in primary care teams to help individuals and families find the resources they need. What we learn from this effort informs enhanced collaborations to address needs in the fabric of our local communities.