By Rebecca Koppel, Program Manager for Field Building & Resources

In mid-March of 2020, The National Center was preparing to announce and begin accepting applications for the Ecosystems Community Learning Collaborative (Learning Collaborative). The Learning Collaborative is a results- and action-oriented convening to support organizations in developing and strengthening ecosystem approaches to serving the root cause needs of medically and socially complex populations. When COVID-19 began its rapid spread throughout the United States and around the world, these plans were postponed as we knew that health systems, public health institutions, and community partners would be hyper-focused on meeting the basic needs of their communities.

As the pandemic continued for weeks and then months, we saw a continued focus on basic needs, but we also saw that those needs were best met through partnership. We found that communities with cross-sector partnerships that had existed pre-pandemic were more prepared to address this crisis. These stories inspired us to keep working to understand and help build complex care ecosystems across the country. Although the timeline was delayed, the mission to understand and build ecosystems remained as critical as ever.

After a call for submissions was announced in October 2020, the National Center closed Learning Collaborative applications in January 2021 and is excited to share the lessons from the application process and to announce the six participating teams.

First, what are complex care ecosystems? What do we know about them and what is still unknown?

Complex care ecosystems are composed of organizations in a community that are working collectively and intentionally across sectors to better address the root causes of poor health and well-being, and health inequity among populations with complex health and social needs. We have seen across the country that when organizations work across sectors to methodically address population-level needs, the health and wellbeing of individuals with complex needs is improved. Through engagements with multiple community-based organizations, government offices, health systems, and communities, the National Center has developed an approach to partnering with communities to develop complex care ecosystems. This approach includes:

• Creating the structures for cross-sector collaboration, 
• Data sharing and analysis, 
• Asset mapping of resources, 
• Ecosystem mapping of the continuum of services, 
• Gap identification, 
• Continuous process improvement, and 
• Storytelling.

However, there is still a lot we have left to learn. We don’t know which ecosystem configurations are best for which communities and for specific desired outcomes. We have yet to name the elements of an ecosystem or even precisely define it. There is also more to learn about the best practices for teaching organizations how to develop complex care ecosystems in their communities.

What is the Ecosystems Community Learning Collaborative?

The Ecosystems Community Learning Collaborative is an action-oriented opportunity for teams to learn from peers and technical experts about how to rapidly expand and sustain cross-sector partnerships to address the needs of individuals with complex health and social needs. The National Center is providing this opportunity to six teams across the country and will also use what we learn to develop and share tools, resources, and guidance with the broader field of complex care.

We received many impressive and diverse applications, and conducted several rounds of review before selecting the six teams. The application process itself was informative and introduced us to communities newer to our network and the wider field of complex care. It also showed us what ecosystems can look like around the country.

Who applied to the Learning Collaborative?

Learning Collaborative applicants represented a number of different sectors. Applicants were primarily based in healthcare, followed by community-based organizations, conveners, payers, and the government.

Percentage of Learning Collaborative applicants by sector

Organizations submitted applications from all over the United States, from both urban and rural environments.

Locations of Learning Collaborative applicants

Who was accepted?

We are excited to announce the six selected Learning Collaborative members who will be joining the Camden Coalition to explore what successful complex care ecosystems look like across the country:

• AccessHealth Spartanburg: AccessHealth Spartanburg’s mission is to improve access to healthcare for the uninsured of Spartanburg, Cherokee, and Union counties in urban and rural South Carolina. They are partnering with Jumpstart, Spartanburg Area Mental Health Center, and the South Carolina Vocational Rehabilitation Department to support individuals leaving incarceration with accessing housing, healthcare, behavioral health, case management, and employment services. This complex care ecosystem aims to reduce recidivism, improve health outcomes, and reduce unemployment among individuals leaving incarceration in their communities.
• Allegheny County Department of Human Services: Allegheny DHS is the administrator, lead organization, and Unified Funding Agency of the Pennsylvania county’s homeless Continuum of Care (CoC). They are partnering with the Center for Inclusion Health, Bethlehem Haven, Salvation Army Family Caring Center, Pleasant Valley Shelter, Squirrel Hill Health Center, and Healthcare for the Homeless to strengthen partnerships between Federally Qualified Health Centers and homeless shelters. This complex care ecosystem aims to improve healthcare outcomes for individuals experiencing homelessness and to reduce the cost of emergency department services.
• Atlanta Regional Collaborative for Health Improvement (ARCHI): ARCHI is a collaborative of 110 organizations aligned around a 28-year commitment to improving health in the metro Atlanta area. They are partnering with Grady Health System, St. Joseph’s Mercy Care, First Step Staffing, Hope Atlanta, Open Doors Atlanta, and the Atlanta Community Food Bank. This complex care ecosystem has created Community Resource Hubs that identify and address the unmet social and economic needs of patients struggling to manage their chronic conditions.
• Camden Coalition of Healthcare Providers: The Camden Coalition’s mission is to spark a field and movement that unites communities of caregivers in Camden, NJ, and across the nation to improve the well-being of individuals with complex health and social needs. We are partnering with Oaks Integrated Care, Virtua’s Psychiatry and Emergency Departments, and Cooper University Hospital’s divisions of Psychiatry and Emergency Services. Our complex care ecosystem aims to connect reconnect patients to outpatient mental health and substance use treatment services following presentation to the emergency department.
• Rady Children’s Hospital – San Diego: Rady Children’s Hospital’s mission is to restore, sustain, and enhance the health and development potential of children through excellence in care, education, research, and advocacy. They are partnering with the Urban Collaborative Project and the Center for Healthier Communities in San Diego, CA. Their complex care ecosystem aims to improve the emotional well-being of children with complex needs and their families.
• WellSpan Health: WellSpan Health is a nonprofit integrated healthcare delivery system in central Pennsylvania and northern Maryland. They are partnering with the York County Department of Probation Services (Community Action for Recovery and Diversion initiative) and the York County Reentry Coalition. This complex care ecosystem aims to achieve health equity and increased well-being for populations experiencing substance use, mental health, chronic medical, and/or poverty resulting from or resulting in interactions with the criminal legal system.

Lessons learned based on the applications

While each application was specific to the applicant’s community and population of interest, there were a few lessons that emerged from the application process itself:

1. Applicants showed a lot of creativity in their ecosystem structure. Some of the ecosystems were based in health clinics but others met individuals in different settings such as schools, homeless shelters, and jails. Two learning collaborative participants are developing ecosystems in partnership with the criminal legal system and with individuals who have histories of incarceration or who are currently incarcerated. This emphasized the importance of meeting people where they are — in the street, in the shelters, or in the jails.
2. Ecosystems can look very different from each other! The ecosystems we got to know through the application process vary in several ways. For example, some are coordinated by an independent backbone organization while others are coordinated by a volunteer participant. Some ecosystems are using an established care model with a new population or new partners while others are developing a new model of care. We have more work to do to collect information on all the ways that ecosystems differ and to understand the implications.
3. One of the most common needs from the teams was help with data sharing, data analysis, and using data to improve service delivery. We see that this is a challenge across projects and sectors and from the field broadly. We will continue to seek opportunities to build data-sharing and analysis capacity in communities, improve our data technical assistance, and create and share relevant tools for the field.
4. Many teams wrote and spoke about how they are currently engaging or plan to engage consumers and individuals with complex health and social needs in the process of developing and sustaining their ecosystem. We know the importance of authentically engaging community members and look forward to continuing to learn what this can look like across organizations. We will partner with the selected teams to continue working towards these community/consumer engagement goals while building our own capacity to offer this type of support.
5. The teams also emphasized a goal of health equity. We know that complex care must be equitable; if it is not, it is not serving the most marginalized. These goals are vital, but we as a field still have a long journey ahead. The leadership of the applicant ecosystems is largely white, and reflects a well-documented gap in racial leadership witnessed across the non-profit sector and healthcare sector. We know that this is incongruent with the diverse and often disproportionately Black, Brown and Indigenous populations with complex health and social needs, and that this power imbalance is the result of centuries of structural and personal racism and discrimination. As a field and as individual organizations, when we set and drive equity agendas, we need to include looking within our organizations in addition to looking at our communities.

Next steps

We are excited to support the six selected ecosystems’ growth over the next 15 months and to continue sharing the Learning Collaborative’s lessons with you.

Are you interested in working with regional partners to address a need in your community? The complex care regional convenings application is now open!