By Hannah Mogul-Adlin, Communications Manager

Every year the National Center brings the complex care field together for the annual Putting Care at the Center conference. Usually an in-person event, Putting Care at the Center 2020 was our very first virtual forum. Despite being held virtually due to the COVID-19 pandemic, this year’s conference was our biggest yet, with 770 registrants. 

On October 27-28, complex care professionals from across the country logged on to hear about and discuss how the major events of 2020 — from the COVID-19 pandemic to the uprisings for racial justice to the 2020 elections — will affect the lives of people with complex health and social needs and the delivery of complex care. This year’s conference theme was Teamwork, resilience, and health justice in complex care.

Health justice — racial equity in particular — was the focus of this year’s keynote address, delivered by Dr. Uché Blackstock, Founder and CEO of Advancing Health Equity. Dr. Blackstock took attendees through a brief history of structural racism and racial injustice in America. Housing discrimination baked into the New Deal and the GI Bill, she noted, has resulted in a wide racial wealth gap. Many medical advances were made through the exploitation of and human rights violations against Black people throughout the world, leading many Black Americans to feel rightful mistrust of healthcare and other institutions. One of the results of these centuries of structural racism and racial injustice is the significant health inequities Black Americans experience to this day. 

To counter structural racism, she offered the framework of structural competency as a tool for providers to begin addressing inequities. Structural competency recognizes the impact of social structures on patient health and on the practice of healthcare — on what happens in the clinic as well as beyond the clinic’s walls. It offers tools and strategies to address racism at each six different levels: individual, interpersonal, institutional, community, research, and policy.

“Often we hear about race being a risk factor for a disease, but the risk factor is racism. It’s how racism shapes the opportunities and lives of people in this country,” said Dr. Blackstock. “It’s important to know this history because in order to do the work we’re doing now we have to address the damage that’s been done over centuries.”

New offerings from the National Center

Providing high quality complex care takes teamwork, and two presentations on the first day of the conference offered the field new tools to develop complex care teams and include consumer voices in complex care work.

The first was the unveiling of brand new complex care core competencies for frontline providers. Developed over the last year by an expert working group, the competencies capture the knowledge, skills, and attitudes needed by all complex care providers, regardless of discipline, profession, or sector. The complex care core competencies report, as well as an accompanying brief and two resources for implementing the competencies in complex care practice and education, can be found here. 

The second presentation was for Amplify, a new consumer voices bureau from the National Center. More than a conventional speakers bureau, Amplify allows organizations to partner with complex care consumers on projects and programs as well as requesting consumers as speakers for events. Centering the lived experience and expertise of consumers is critical for complex care programs to be effective and advance equity. “If you ask the people who have been there and lived it, you will get a much better solution to whatever the problem is that you’re having,” said Joanne Guarino, Community Advisory Board member for Boston Healthcare for the Homeless and Amplify participant.

Resilience through a pandemic

Resilience was another theme of the conference, and this year’s eight plenary presentations and over 40 Beehive presentations showcased the deep resilience of the complex care field. The COVID-19 pandemic has upended the infrastructure and funding sources that many complex care programs rely on, while also disproportionately affecting individuals and communities with complex care needs. The organizations, programs, and partnerships across the country that shared their work have all pivoted quickly to support their participants through a difficult and uncertain time. 

In the Resilient ecosystems plenary, two leaders of cross-sector community partnerships discussed how the trust and strong relationships they had built before the pandemic enabled them to shift focus and continue working in concert once COVID-19 came into their communities. “Everybody brought a unique perspective — I don’t think one organization could have done it by itself,” said Cesar Armendariz, Senior Director of Community Health at Inland Empire Health Plan. “But by repurposing our functions, we were able to do this and we were able to do it quickly.”

In a plenary on social isolation and loneliness beyond COVID-19, Parinda Khatri, Chief Clinical Officer of Cherokee Health Systems, noted that care is really the foundation of resilient systems. “We take care of each other,” she said. “And if we set that standard and expectation, that goes a long way in reducing stigma and improving access.”

Working toward health justice

Many of the plenaries tackled the theme of health justice as well. In Health equity through community empowerment, Noha Aboelata, Founder and CEO of Roots Community Health Center, noted that “We cannot program and service our way out of the disparities that exist; we have to advocate for systems to change… We didn’t get here by accident,” she said. “The systems are structured in a way that maintains disparities. If we’re going to overcome those disparities, we have to think about changing those systems.”

Plenary speakers were clear that these system changes need to be driven by consumers and community members. “How do we find out about people’s needs? How do we find out about people’s priorities? Well, engaging that community themselves and the leaders in those communities is the tried and true method, and we need to make sure we’re being honest and authentic about that,” said Cindy Mann, Partner at Manatt Health, in a plenary on the current state of complex care financing.

Community involvement “doesn’t just mean making sure people are at the table at the outset, and then policymakers keep moving forward based on that input,” said Emily Stewart, Executive Director of Community Catalyst, in a plenary about the 2020 election. “It’s critical that the voices of those who are most impacted are at every table all along the way.”

Consumer leadership is critical to effective care delivery as well. In a plenary on supporting a diverse workforce, Adrian Burris, Program Director at 4D Recovery, talked about his journey from participant to staff member. “There’s a lot of things I learned in treatment,” he said, “but a lot of that wouldn’t really have as much of an impact if I wasn’t involved in a peer-run organization delivered by people with lived experience.”

What’s ahead

“So much of what we do in healthcare continues to be based on a fundamental lack of trust and a devaluing of people who understand very well what it means to live with a complex clinical and social condition, and who want very much to exercise their agency to change their circumstances,” said Kedar Mate, CEO of the Institute for Healthcare Improvement. 

In the Envisioning the future of complex care plenary, Kedar joined Allison Hamblin, CEO of the Center for Health Care Strategies, in listing the top ten headlines they imagined for the future of complex care. These included getting smarter about risk, embracing nuance, paying differently, and creating accountability for equity. In this imagined future, Allison said that she hopes “we [will] finally recognize and appreciate that the health of a society is only as strong as the conditions that exist for the most vulnerable among us.”

This year’s conference also took place days before the 2020 election, a major point of focus for many in the complex care field. In a plenary called The next four years, Sadena Thevarajah, Managing Director at HealthBegins, told attendees that “this is the time to continue to strategize and organize. The election is not a finish line. It’s a way to make sure we have the most favorable organizing conditions.”

In his closing remarks, Mark Humowiecki, Senior Director of the National Center for Complex Health and Social Needs expressed his pride and admiration for the complex care community. “While we know the last eight months have been incredibly challenging,” he said, “it’s also been a period of resilience and ingenuity, perseverance and teamwork.”

Putting Care at the Center 2020: Virtual ended with a bang, in a way that was only possible in a virtual format: with an exclusive pre-filmed performance from Gina Chavez, a 2020 Latin Grammy nominee and advocate for survivors of domestic violence with Survive2Thrive. Gina joined attendees in the virtual conference platform’s chat box as her show played and attendees danced and celebrated in their homes and offices across the country. 

We missed meeting in person this year, but 2020 showed how adaptable and dedicated the complex care field truly is. We hope to see you in the networking activities, chat boxes, discussion sessions, and more next year for Putting Care at the Center 2021: Virtual.