Key themes in complex care emerge from Putting Care at the Center 2022

Hannah Mogul-Adlin, Senior Communications Manager

Building the complex care field Convening

After two years of virtual conferences due to the COVID-19 pandemic, in 2022 more than 500 members of the complex care community celebrated the opportunity to come together in person in Sacramento, CA. Complex care providers, payers, researchers, consumers, policymakers, and more gathered September 21-23 to learn, share, hear from experts from across the country, and explore this year’s conference theme: Values and value in complex care.

This year’s conference was also our first experiment with a hybrid virtual/in-person format. Virtual participants were able to watch and participate in the main stage sessions (keynote, plenaries, story share) and select workshops live, and to watch pre-recorded workshop sessions.

As always, the annual conference for the complex care field was characterized by a buzz of recognition, relationship-building, and shared purpose among conference veterans and newcomers alike.

“These are your allies, not your competition,” said Shelly Trumbo, Well-Being Executive at conference co-host Adventist Health, in her welcome remarks. “Now is the time for us to align together in new and different ways to create the future that we envision.”

The theme of collaboration was echoed by keynote speaker Jennie Chin Hansen, trailblazer in designing and scaling PACE, an integrated, community-based care model for older adults. “Our society is an ecosystem, and the sooner we recognize that instead of protecting our turf, the sooner we can mobilize for a more equal society, a society that has decency and a future.”

Camden Coalition President and CEO Kathleen Noonan opened the conference by introducing the Camden Coalition’s 2022-2025 strategic plan, which is centered around the ambitious goal of strengthening ecosystems of care in 500 communities across the country. “There’s so much change that really needs to happen in healthcare,” she said. “We never want to rest on what we might have accomplished today; we always want to feel like our goals are audacious and huge.”

Rethinking the value of complex care

A major theme of the 2022 conference was rethinking value: exploring the many ways that complex care programs and approaches improve the experiences and quality of life of participants and providers, and how they improve efficiency and connectedness of care systems as a whole.

The success of complex care programs has traditionally been measured by whether they save money for healthcare systems and reduce acute care utilization of the individuals they serve. Recently, complex care leaders and advocates have questioned whether cost and utilization are really the most important metrics to determine a program’s success.

In a plenary session called “Demonstrating the full value of complex care,” panelist Chris Esguerra, Chief Medical Officer of the Health Plan of San Mateo, noted that focusing on cost, return on investment (ROI), and high utilization “ignores a population that isn’t able to access care, period.” Because of that, he explained, “this focus on cost is a reinforcement of the current [healthcare] structures.” Chris proposed that a truly value-based approach looks like “centering the most vulnerable of your population, designing there, making that work, and then using those universal design principles to apply to the rest of your population.”

Fellow panelist Sarah Scholle, Vice President of Research and Analysis at the National Committee for Quality Assurance, shared her excitement about a set of measures in development called “person-centered outcome measures.” Unlike with patient-reported outcome measures, person-centered outcome measures allow patients or participants themselves to set the goals that are being measured. “We want care teams to sit down and say ‘What matters most to you in your life? How can your healthcare support what matters to you?’” Sarah said. Preliminary data suggests that organizations using person-centered outcome measures may see a reduction in their participants’ hospital days and emergency department visits, she noted.

In a workshop on rethinking value for cross-sector partnerships, attendees listed a wide host of benefits they have seen from cross-sector collaboration, including wider reach, improved staff retention, learning best practices, and more lives saved or improved. “We’re re-learning what value is,” remarked one attendee, “but the problem is that the people in power still define value as making money.”

Aligning health and social care by empowering CBOs

In an earlier plenary session called “CBOs in their own words: Data-sharing, financing, and equitable partnerships,” panelists made the case for bringing community-based organizations (CBOs) together into resilient, well-organized networks. “We want to invest in a community network that will be here for years and years to come, and not change with every change in funding,” said Sarah Redding, Founder of Pathways Community HUB Institute.

Panelists noted that CBO networks are particularly well-suited to meet community members’ interconnected health and social needs. Nikki Kmicinski, Executive Director of Western New York Integrated Care Collaborative, Inc shared that in her experience, 23 is the average number of social needs per individual that show up on social determinants of health (SDOH) screenings. Luckily, she said, “we have CBOs in our network that can cover all of those needs.”

Plenary moderator Tim McNeill, Chief Operations Officer and Founding Member of Freedmen’s Health, also co-chairs the Partnership to Align Social Care, a cross-sector effort to enable successful partnerships between healthcare organizations and networks of CBOs. At a workshop on Wednesday, presenters highlighted the work of the Partnership, focusing on the promise of delivery structures called Community Care Hubs. As more states begin allowing (or requiring) healthcare systems and plans to provide non-medical services, Community Care Hubs organize and provide the infrastructure for CBO networks to contract with health plans and accountable care organizations.

Speakers in the “Demonstrating the full value of complex care” session also identified funding and support for community-based organizations and people with lived experience as a critical investment in strong complex care ecosystems. Panelist Janice Tufte, National Consumer Scholar alum, relayed how in Seattle, WA, county-level investment in hyperlocal community organizations had resulted in “a widespread empowerment. Now there are people with lived experience sitting on almost every [local government advisory] board.”

Living our values

Other parts of the conference focused on values, and how we define and live our values as a field. Outside of the conference’s interactive Beehive, attendees wrote what they value about complex care on leaves that they stuck onto a “values tree.” Crowd-sourced values included empathy, perseverance, accountability, silo breakdown, and lived experience.

During the story share session on the first evening of the conference, attendees with lived experience of complex health and social needs — many of them current National Consumer Scholars — described how feeling valued and in community allowed them to flourish. Storytellers shared how they turned trauma into reparative action: developing a summer camp for disabled individuals and their caregivers, creating a program to help formerly incarcerated individuals re-enter society, becoming advocates and peer support workers who help others speak up and take back their power.

“Stories construct societies through policies, institutions, and systems,” said facilitator Luis Ortega, Director of Storytellers for Change. “They shape what care means — who we care for, who we don’t.”

“Because I care, I courageously share my vulnerability for systemic transformation,” said National Consumer Scholar LaRae Cantley. National Consumer Scholar Connie Montgomery agreed. “We all are the medicine for each other,” she said. “In humanity and in healthcare, keep pressing forward.”

At this conference, we also began digging into the “how” of living our values. “We are now calling out structural racism and systemic injustice — but how do we also measure these things that we want to dismantle?” asked moderator Natasha Dravid, Senior Director of Care Management & Redesign Initiatives at the Camden Coalition, to open the plenary session on demonstrating the full value of complex care.

Earlier in the day, speaker Keris Myrick, Vice President of Partnerships at Inseparable, shared an answer during her fireside chat on “True consumer leadership: Redesigning complex care initiatives to put those with lived experience at the center.” “You can’t medicate away racism,” she said, but there are ways we can work together to address it. One starting point is to ask yourself: “what do the demographics of your community look like, and are you seeing these great outcomes equally among the demographics of your community?”

Keris and moderator Victor Murray, Senior Director of Community Engagement & Capacity Building at the Camden Coalition, talked about the messy, nonlinear work of community engagement. “There’s a lot of work that needs to happen before people even get to the table and feel comfortable being there,” Victor noted.

Living our values often looks like committing resources and compensating individuals equitably. Thinking of consumers as partners, not just patients, means “valu[ing] people’s intellectual property,” said LaRae Cantley during a workshop on thriving and surviving after a medical diagnosis. “Our nuggets of wisdom are being used to develop programs, policies, and strategic plans — at the very least we need to be compensated.”

CalAIM: A bold experiment in complex care

We picked this year’s conference location of Sacramento, California’s capital city, in order to spotlight the country’s leading edge of complex care innovation. The state is 9 months into implementation of CalAIM, a five year plan to transform Medi-Cal, California’s Medicaid system, to provide coordinated, equitable, and person-centered care. Under CalAIM, Medi-Cal beneficiaries with complex health and social needs will receive enhanced care management as well as “community supports” — 14 non-medical benefits that address health-related social needs.

CalAIM is the largest at-scale complex care experiment in the country, and excitement throughout the conference was palpable. Opening one of the conference’s four “CalAIM Town Halls,” moderator Dan Gorenstein, founder of the Tradeoffs podcast, took a moment to reflect on the policy’s significance. Where in past years a discussion of a state Medicaid office taking on social needs would be purely theoretical, he remarked, this year “we’re not having a conversation about vision or what ifs, we’re having conversations about brass tacks.”

On the conference’s final day, Dan was joined on the main stage by CA State Medicaid Director and CalAIM architect Jacey Cooper for a plenary called “California’s ambitious plan to revolutionize complex care.” “[In California,] we’ve been paying for care coordination in healthcare for a long time,” she said, “but CalAIM is taking it to another level, where we can really change the trajectory of someone’s life.”

“I will know [CalAIM] is working when the right person is connected to the right care at the right time, people’s health is actually improving, and they’re living healthier and happier lives,” Jacey continued. “Even if CalAIM ends up being cost-neutral, it will be worth it.”

During the plenary, Dan also introduced Dale Stout, a Medi-Cal beneficiary, and his doctor Pooja Bhalla, co-CEO at the Illumination Foundation. Dale, who was experiencing homelessness, was able to receive the respite care he needed to safely recover from a stroke-induced coma because of CalAIM. Prior to CalAIM, funding for medical respite care was extremely limited, said Dr. Bhalla. “CalAIM has totally transformed that,” she noted. “We are now able to accept clients like Dale and others who need a safe place to recuperate, who can’t recuperate in the shelter or on the street.”

However, one big gap in CalAIM as currently implemented is the state’s lack of permanent, supportive housing solutions for those experiencing homelessness. “95 Illumination Foundation clients have vouchers in their hand for housing that are about to expire,” Dr. Bhalla said. Dale is one of them — if he can’t find housing by early December, his temporary housing benefit will end and he will likely return to homelessness.

“I think of [CalAIM] as a build, I don’t think of this as flipping a switch,” said Brian Hansen, Policy Advisor to the Directorate at the California Department of Health Care Services during Wednesday’s CalAIM Town Hall. His fellow panelists agreed. “We have a lot to celebrate,” said Amber Kemp, Vice President and Medi-Cal Regional Lead at HealthNet. Providers and payers across the state all working with the same funding within the same structure means that “we’re all part of the same care team at the end of the day,” said Leepi Shimkhada, Deputy Director of Housing for Health at the Los Angeles County Department of Health Services. “​​This is the start of building the foundation.”

A celebration of collaboration

“Our real challenge is figuring out how we get statements of values and value that drive healthcare in the direction we want to go,” Camden Coalition President and CEO Kathleen Noonan noted in her opening remarks.

Putting Care at the Center 2022 rose to that challenge. In workshops, in plenary Q&A sessions, in the Beehive, and over appetizers at the welcome reception, attendees shared their lessons and opportunities, failures and successes. “We’re now more than ever bringing down the walls of silos so people can work together with an open view,” keynote Jennie Chin Hansen observed.

In the story share, host Luis reflected on the stories he heard. “There’s something to be said for being medicine for each other, but also being medicine for ourselves,” he said. “I need to be my own advocate, but I need you to reaffirm my agency. There’s this beautiful reciprocity here if we make space for it.”

“There’s more than enough work for all of us,” said Mark Humowiecki, General Counsel and Senior Director at the Camden Coalition, in his closing remarks. “Your generosity of spirit is what will make it happen.”

Throughout the conference, speakers and MC Gladys Antelo-Allen echoed the words spoken by Don Williams, Director of Community Relations at Jumpstart, in the story share. “On hard days when you want to throw in the towel, I want to encourage you with these three things,” he said. “Keep grinding, keep growing, and keep on going.”

Join us next year in Boston

Putting Care at the Center 2023 will be held in Boston, MA, November 1-3, 2023, co-hosted with Commonwealth Care Alliance and the Center to Advance Consumer Partnership. Sign up for our newsletter to be first to hear about how you can apply to present, sponsor the conference, or register to attend.