Much like the subset of individuals we see in health care who are experiencing high hospital use, people also repeatedly cycle in and out of correctional facilities. When these individuals are released back into the community, many rely extensively on hospitals, rather than on outpatient primary or specialty care, for their health care needs.
The Camden Coalition wanted to build on what we have learned through the Camden Core Model to understand whether and how we could be effective in improving the health and well-being of people in this population. Our jail-based reentry pilot, called Camden RESET and funded by Arnold Ventures, enrolled individuals while they were incarcerated to provide person-centered wraparound care management.
In this article, published in NEJM Catalyst, we draw on our care team’s experiences, program participants’ perspectives, and data analysis to share lessons, challenges, and outcomes from Camden RESET. Key takeaways include: the importance of cross-sector data sharing relationships; authentic healing relationships with providers give participants the ability to build trust, hope, and competence; and investing time and resources in building partner organizations’ capacity helps build complex care ecosystems.