What are ecosystems of care?

Camden Coalition staff work closely with local partners during the COVID-19 pandemic host vaccination events to alleviate vaccine hesitancy and reduce gaps in vaccine compliance in the community.

A ecosystem of care is a local network of organizations, sectors, fields, and/or professions working collectively to address the root causes of poor health among individuals with complex health and social needs.

Released in the fall of 2018, the Blueprint for Complex Care borrowed language from environmentalists in calling for the creation of ecosystems of care.

Ecosystems of care may include:

consumers and families,
health systems and practitioners,
diverse community-based organizations,
public health thinkers and doers,
social service and behavioral health organizations,
payers,
educators,
first responders,
faith-based organizations, and more.

How do ecosystems of care support people with complex needs?

People with multiple conditions and barriers need services from multiple organizations and sectors, and are falling through the cracks of our fragmented health and social service systems.

Ecosystems of care advance health equity and improve the effectiveness, efficiency, experience, and quality of care by:

Sharing information. Sharing real-time, detailed information from multiple sources (i.e., community-based organizations, public health, and health systems) on an individual’s conditions, circumstances, and goals means all providers have a holistic view of the individual and can tailor care accordingly.
Building trust and relationships. Ongoing, trusted relationships – between community members and providers as well as between organizations in a community – allow for better, more coordinated care. Building these relationships requires that organizations put aside competing interests and collaborate for the good of their shared patients.
Reducing duplication of services. Providers can specialize in what they’re best at when they know that the holistic needs of their patients are being met by partner organizations. This means a more efficient and integrated system of care with less waste.

What does a strong ecosystem of care look like?

Our Ecosystem Assessment Tool defines the attributes of a strong ecosystem of care:

Workforce

A well-prepared, diverse, interprofessional workforce that is supported to deliverhigh 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.

Explore the Ecosystem Assessment Tool

President and CEO Kathleen Noonan addressing the importance of building ecosystems of care in her opening remarks at Putting Care at the Center 2019

The most powerful examples of successful ecosystems of care feature local and regional communities coming together, honestly evaluating their systems, understanding who’s at the table, and identifying who’s missing and marginalized. This is the hard work of building authentic, healing relationships—and it’s absolutely necessary.

How do I start building an ecosystem of care in my community?

Our Ecosystems 101 brief has the information and examples you need to get started. Ready to go deeper? Use our Ecosystem Assessment Tool to:

Identify your ecosystem’s strengths and areas that need improvement
Assess your ecosystem’s level of maturity
Articulate and measure the impact of cross-sector programs and initiatives on your ecosystem of care

Learn from our work strengthening ecosystems of care in South Jersey and in communities across the country.

More tools and resources:

Check out the Data & process improvement and Community mapping & collaboration sections of the Complex care startup toolkit
Use the value case summary tool in the Building the value case for complex care toolkit to demonstrate the return on investment (ROI) of your program or ecosystem
Brush up on your complex care skills and train your team with the Complex Care Certificate and our other offerings on the Camden Coalition Learning Center

Upcoming webinar

When clinicians become family caregivers

Feb 5

When clinicians become family caregivers

Physicians, nurses, and other healthcare professionals who become family caregivers to their own family members often deal with complex situations. This webinar seeks to share strategies so caregivers can best support their loved ones.

Virtual 2 – 3 pm ET

The ROI of resource navigation: Findings from the Accountable Health Communities Model