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Ecosystem Assessment Tool

How strong is your community’s ecosystem of care?

Building the complex care field Strengthening ecosystems of care Measurement & evaluation Quality improvement SDOH & health equity

Each domain has specific attributes that form the framework for the Ecosystem Assessment Tool. Workforce domain has the attributes teaming and collaboration, training in core competencies, and community representation. Services domain has the attributes whole-person care management, screening and referrals, performance monitoring, and best practices and innovation. Data & measurement domain has the attributes community data sharing, participant engagement in data sharing, analytics and workflows, and shared quality metrics. Leadership & governance domain has the attributes coordination across stakeholders, breadth of network, and equitable leadership and decision making. Payment & funding domain has the attributes resources for whole person care and aligned incentives on value. Finally, the consumer participation domain has the attributes authentic consumer engagement, consumer-informed decision making, and sustainable resources dedicated to consumer engagement.
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What does a strong ecosystem of care look like? How can we measure the impact of our work on our communities’ ecosystems of care?

The Camden Coalition developed the Ecosystem Assessment Tool as a continuous quality improvement framework to answer those questions. The tool is designed to help partners within an ecosystem of care:

  • Identify current strengths and areas for improvement
  • Assess the ecosystem’s level of maturity
  • Articulate and measure the impact of cross-sector programs and initiatives

Building and strengthening a coordinated ecosystem of care is a powerful way to advance health equity. No single organization or sector can solve complex, deeply rooted health inequities alone, but by bringing partners together we can address inequities at the community level. And in order to track our collective, community-level impact, we need a way to define and measure it.

We started by defining six domains of a strong ecosystem of care. Expand each domain for more information.

Workforce

A well-prepared, diverse, interprofessional workforce that is supported to deliver​high quality, person-centered care. ​The workforce should include people from the community served.​

Workforce members should be trained ​to think creatively and to collaborate effectively with program participants ​and partners.

Services

Ecosystem partners continuously evaluate the continuum of services that are needed by the community served to ensure that services are accessible and effective. ​

Ecosystem partners ensure service gaps are filled and that care management supports individuals to achieve their identified goals in a timely manner.

Data & measurement

Organizations generate, share, and use quantitative and qualitative data to identify and understand the populations they serve, assess needs, coordinate services, adapt best practices, and continuously measure and improve the delivery of care and support.

Leadership & governance

A well-functioning process and structure ​for identifying priorities, designing and improving services, and collaborating with all relevant stakeholders, including communities and people with lived experience (PWLE).​

Leaders recognize the power differentials among participants and seek to share power.

Payment & funding

Resources and payment arrangements ​are directed to the organizations and services that are essential to improve the health and well-being of the populations served, particularly community-based organizations and those providing non-medical services for health-related social needs.

Consumer participation

Community members and people with lived experience are key stakeholders who are meaningfully engaged in shaping all aspects of care delivery, program design, quality improvement, and governance.

We then built those domains out into a framework, with 2-4 attributes under each domain:

Each domain has specific attributes that form the framework for the Ecosystem Assessment Tool. Workforce domain has the attributes teaming and collaboration, training in core competencies, and community representation. Services domain has the attributes whole-person care management, screening and referrals, performance monitoring, and best practices and innovation. Data & measurement domain has the attributes community data sharing, participant engagement in data sharing, analytics and workflows, and shared quality metrics. Leadership & governance domain has the attributes coordination across stakeholders, breadth of network, and equitable leadership and decision making. Payment & funding domain has the attributes resources for whole person care and aligned incentives on value. Finally, the consumer participation domain has the attributes authentic consumer engagement, consumer-informed decision making, and sustainable resources dedicated to consumer engagement.

To use the tool, score each attribute on a scale from limited practice to advanced practice:

Attributes are defined across 4 levels to determine maturity of current ecosystem capabilities and processes. Ecosystem assessment tool scoring (attribute levels): Level 1 - Limited practices: limited processes and practices in place to achieve attribute goal. Level 2 - Promising practices: some processes and practices in place to achieve goal. Level 3 - Strong practices: Most processes and practices in place to achieve goal. Level 4 - Advanced practices: Advanced processes and practices in place to achieve attribute goal.

You can apply the scoring rubric to every attribute in the framework for a comprehensive assessment of the current state of your ecosystem of care. Or select target attributes to score before and after the implementation of a program or project to determine its impact.

See below for an example of using the rubric to measure the impact of a project on the “teaming and collaboration” attribute under the workforce domain:

Title reads: Teaming and collaboration: Care team members are collaborating and coordinating internally and externally (across organizations and sectors). From left to right, in columns of green and white, the text reads: Level 1 (Limited practices): Individual care team members work in silos – internally in large institutions and externally. Level 1.5 (Baseline): Our current project team is somewhere in between 1 and 2. Level 2 (Promising practices): Care team members consult with some external organizations or across internal care management teams in large systems. Level 2.5: Our current project team is somewhere in between 2 and 3. Level 3 (Strong practices): Care team members work collaboratively within and across organizations to serve individuals and/or populations. Level 3.5: Our current project team is somewhere in between 3 and 4. Level 4 (Advanced practices): Care teams coordinate social, behavioral, and clinical care with staff from multiple organizations.

We are in the process of building more materials to help people use the Ecosystem Assessment Tool in their communities. We want to hear from you: what are we missing? What would be helpful for you to put this tool into practice? Please send any feedback to Natasha Dravid at [email protected].

For more information about the Ecosystem Assessment Tool, watch the webinar recording.

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