Academy Award Winning actor, New York Times best-selling author and Impact Investor, Matthew McConaughey chats with Dan Brillman and Taylor Justice, CEO and President of Unite Us, about the importance of investing in social care to reduce health disparities.

A dedicated investor in Unite Us, Matthew shares our belief that every American deserves to access the help they need with dignityand respect. He and his wife Camila founded the just keep livin Foundation, which is dedicated to helping teenagers lead active lives and make healthy choices to become great men and women.

The virtual town hall took place on November 1, 2021, featuring an opening conversation with Matthew McConaughey, Dan Brillman, and Taylor Justice and four breakout panels with leaders in the world of SDoH. See below for details about each breakout session.

Watch the Town Hall

Social Care Has Arrived

Social care has become its own industry, and the market has demonstrated readiness to invest in the future of health and community well-being. In this session, hear from market investment leaders blazing this path as they outline the rationale behind their investments, expected outcomes, and trends they are keeping their eyes on. This session, moderated by Unite Us chief strategy officer Esther Farkas, features market investment leaders with their finger on the pulse of the future of health. Panelists include:

	Caroline Xie General Partner, Iconiq		Sarah Pinto Partner and Senior Director for Venture Investing, Emerson Collective
	Claudine Emeott Vice President and Partner, Salesforce Ventures Impact Fund		Joel Krikston Managing Director for Venture Investments and Vice President and Head of Strategic Innovation Alliances, Merck’s Global Health Innovation Fund, LLC

It Starts with Community

Improved community health through social care delivery is only possible with deep community partnerships. In this session, learn how you can best support community efforts, drive progress with data and insights, and increase health equity at the local level. Hear about the latest resources for clients in need from innovative leaders in the SDoH space. Moderated by Unite Us’ chief solutions officer Kelly Binder, the panel discussion features:

	Mark Belanger Chief Executive Officer, Integration Sciences		Hector Gutierrez Strategic Initiatives Specialist and Special Projects Director, First 5 Kern
	Jim Zenner Mental Health Clinical Program Manager III, Los Angeles County Department of Mental Health.

Person-Centered and Secure

Care coordination leads to improved health outcomes and sustainable health equity. Leaders across public health sectors agree that to best meet the needs of people and communities, the social care software and systems we use must be person-centered. The benefits of interoperability go beyond ease of use and efficiency, setting a standard for the industry that prioritizes client confidentiality and secure referral technology. This panel, moderated by Unite Us vice president and regulatory counsel Carlos Uriarte, covers the latest developments in care coordination software and how networks are implementing a client-centered approach to meeting social care needs. Panelists include:

	Libby Bunzli Director of Health System Transformation, State of Rhode Island		Jesse Bailey Executive Director, Pathways Shelter for the Homeless
	Nazleen H. Bharmal, MD, PhD, MPP Associate Chief of Community Health and Partnerships, Cleveland Clinic Community Care and Population Health

Scalable Solutions Built to Last

With federal and state policies aligning on the need for increased social care funding to address SDoH, the potential for scaling regional and national solutions has never been greater. Local-level social care data can be analyzed to inform interventions that lead to large-scale systems transformation. Hear from panelists across state and federal government, national healthcare enterprises, and social care non-profits on the importance of innovating and scaling social care approaches. Moderated by Eric Beane, vice president of regulatory and government affairs at Unite Us, the panel features:

	Duke Storen Commissioner, Virginia Department of Social Services		Michelle (Hinton) Ford Director of Impact, Population Health and Well-Being at the Alliance for Strong Families and Communities
	Alex Billioux Vice President for Social Determinants of Health for UnitedHealthcare Government Programs

Watch the Town Hall

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“In order for a client, or resident in my case, to get the highest level of care necessary, there needs to be solid communication and interconnectedness between resources. Down to a town level in Laconia, we are unfortunately suffering from an extremely terrible mental health and drug epidemic. So, allowing that communication and interconnectedness — really creating a 360 approach for all my residents — it’s necessary. It has to happen.“ – Adam Moulton, Director, Reverence House

Adam Moulton joins Mark Belanger, Founder and CEO of Integration Sciences as well as Daisy Pierce, Executive Director, Navigating Recovery, and Corey Gately, Director of Substance Use Services, Concord Hospital – Laconia/Franklin, in this discussion on their partnership with Unite Us.

For providers ready to learn more, please visit:

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“As a recruiting team, our first priority when launching in a new area is to hire locally. Not only is that talent pool best equipped to serve, understand, and support their neighbors, but this philosophy also attracts ‘A-players’ to our team. ‘A-players’ are high-performing candidates who want to make a broader impact in their next role. Working at Unite Us provides that opportunity to all of us. We can see how our work is impacting the community–our community–and that’s what keeps us dedicated to the mission and our work–no matter the role,” shared Jessica Paddock, Director of Recruiting at Unite Us.

We’re excited to introduce you to some of our new team members from across the country. Meet Kristin Hunter, Raj Madhure, and Gracious Gamiao!

Kristin Hunter, Network Director, Central Region

Kristin started her career in advertising and eventually realized that was not the work to which she wanted to dedicate her time. “I just was not fulfilled. I learned a ton but I was feeling like I was moving away from my internal knowing,” says Kristin. She moved on to roles at Girl Scouts, as well as Susan G Komen Great Plains. Kristin is now the Unite Us Network Director, Central Region. “Helping to build community is my passion, that’s what brings me to life, and that’s the role in which I want to invest my life,” she adds.

Raj Madhure, VP Network Development, Western US

Raj has worked in the healthcare industry for over 20 years holding titles at both Optum and Kaiser Permanente. He is now the Vice President of Network Development, Western US at Unite Us. “What I loved about Unite Us and what really drew me here was the fact that it’s an organization that is a startup environment, is a technology environment, is related to healthcare but has a social mission,” says Raj.

Gracious Gamiao, Community Engagement Manager, Washington

Gracious pursued her Masters in Public Health from the University of Washington, with a focus on community engagement and program evaluation. “I have a background in the nonprofit sector working on community health worker programs, specifically, in my community and the South King County area where there are primarily immigrants, refugees, and people-of-color. For me, it’s really important to be rooted in the work that you do. It carries a lot more weight when I meet with community based organizations because I’m like, ‘I’m your neighbor and I have a vested interest in improving our community together,’” says Gracious.

What/who motivates you to succeed in your role?

Kristin and Gracious are on our Customer Success team, and Raj is on the Network Development team.

Kristin: When you are going through difficulties in your life, you are naturally fatigued because its emotionally draining, and the more you get shuffled around, the more you lose the empowerment to take care of yourself holistically, so helping my community members not fall through the cracks is what motivates me.

Raj: I take very seriously the idea that the whole concept of sales is we want to get more people to use the product. That’s what is exciting to me: how do we get people to want to work with us?

Gracious: Your commitment to the community is crucial to the Community Engagement Manager role, and that’s where it goes back to hiring locally. If you’re from that community, you have a vested interest improving and building on its priorities and the strengths. For me, I’m guided by the work that we do because I know, ultimately, it benefits the larger community that I consider myself a part of, and so I’m driven to respond to emails, to reach out to organizations, and to build these relationships because I know that it can have that long-term impact.

What is your connection to the community you work in?

Kristen’s connection to the Great Plains is pivotal as we support Unite Nebraska. In Washington and California, Unite Us powers networks that are growing daily.

Kristin: In my role at Komen, I covered South Dakota as well as Nebraska and then I lived in Des Moines for seven years, so I know these communities, I’ve lived in them, I’m entrenched in them. Like most communities, having a local footprint is especially important to the Midwest. We want to feel like we’re understood by our neighbors and I think it’s so great that Unite Us is hiring people in local communities because you have a better understanding of the needs that are specific to that community from someone who lives there.

Raj: I have lived in Southern California since I was four years-old. I’ve lived in every different part of Los Angeles, so I very much have had the opportunity to see the disparity within Southern California. I am extremely aware of how the disparities that we have within our neighborhoods look. When I think about what Unite Us does in terms of social services, I’ve had relatives who have needed access to services and fell through the cracks, so I can see how if this had been there 20 years ago, my uncle may not have passed away from all of the healthcare issues he had from being homeless.

Gracious: These are the places that I grocery shop; these are the places where I live and work. This is where my family and I walk; it’s all the social determinants of health and that’s my environment. When I think about Unite Washington, Unite Us, and the role I do, I don’t think about it short-term. I think about it as this very long-term vision because to connect to a community, you can’t do it in a short stint. These relationships take time to grow, to flourish, to cultivate.

How does health equity influence your approach to work with Unite Us?

Unite Us has never been more committed and dedicated than we are right now to fight against injustice, racism, and health disparities that have long impacted communities across the country.

Kristin: We have forgotten members of society and this solution seeks to level the playing field so that no matter your situation you feel like you are seen, you are heard, and you matter.

Raj: The challenge in California sometimes is that we’re so big and there are so many different resources that it’s so easy for people to fall through the cracks. I think something like what we do at Unite Us is all the more critical because it’s even sadder to me if the resources are out there but you’re not getting people to those resources.

Gracious: When I think about health equity, I think about any person based on the intersection of their identities and their communities: could they get access, could they get resources, and be connected in the same way as somebody that has all the privilege? That is the part of our solution and the part of a Community Engagement Manager’s role that intersects with health equity.

At Unite Us, we are so fortunate to have employees that are committed to the communities where they not only work, but live as well. As our partner Dr. Betsey Tilson, Chief Medical Officer for NC Department of Health and Human Services, shared, “What set Unite Us apart was their understanding that technology is just technology and it’s not of value if people don’t actually use it. Unite Us has a deep understanding of and commitment to working with the community.” For us, it’s about working together with members of the community to make a lasting impact and, ultimately, that is why hiring locally matters.

Looking to join a mission-driven, community-led team?

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As we said farewell to 2019, we had no idea what lay ahead – six months into the new year, 2020 has pulled no punches. We find ourselves in the middle of an unprecedented time, all of us collectively navigating this pandemic that has taken far too many lives and left countless people in desperate need of help. At the same time, we’re grieving the racial injustice and pain that Black Americans have faced for decades. Our work today takes on new meaning and urgency as we continue to build upon our model and create solutions that will facilitate care delivery in the most seamless, effective way possible. Unite Us has never been more committed and dedicated than we are right now to fight against injustice, racism, and health disparities that have long impacted communities across the country.

Still, in the midst of the chaos, Unite Us was ready and up for the challenge. By the third week of March, our entire team had seamlessly transitioned to working remotely. We pivoted to align with our partners’ needs in the face of COVID-19.Within a week, we had a COVID-19 strategic plan in place. We were working around the clock to support our existing partners and networks – while simultaneously bringing new ones on board – to help their communities cope with the devastating effects of the virus. Since January, we have launched and starting building new networks in Cleveland, Louisiana, Florida, California, West Virginia, Nebraska, and New York (in both NYC and Syracuse)and began new collaborations with partners that share our visions and values like Lyft, CVS’ Guardian Angels initiative, and Salesforce.

We’ve seen our core values – Think Big, Always Collaborate, Own It and Be A Good Human – exemplified in so many ways during the time our team has been sheltering-in-place. Our parents have become full-time teachers, childcare providers, cooks, and housekeepers while hitting deadlines and never missing a Zoom meeting. Some of our colleagues have donned masks and gloves and headed out into their communities to deliver much-needed food and supplies. Others have contributed through financial donations to the social care organizations on the frontlines every day. We’ve found ways to offer emotional support to each other, through daily check-ins and one-on-one calls, leadership office hours, and amazing team happy hours hosted by our inventive, creative People Ops team.

Unite Us keeps growing and we’ve brought on critical team members who make us stronger and better. 62 new team members have joined the company since January, including Christina Mainelli as Chief Operating Officer and Eric Beane as Vice President, Regulatory and Government Affairs.

As a company, we are humbled and grateful to be able to grow and thrive, even as we see the pandemic’s economic effects on the country. Knowing that advanced data capabilities would benefit our partners and networks, and strengthen our ability to help communities, we’ve recently acquired a SDoH data analytics company,Staple Health. Since 2013, we have been focused on a data standard that does not simply consider searches for resources, referrals defined as printouts of resources, or users that are only individuals searching a directory. Instead, our data illustrates actual service delivery between organizations who are engaged and part of a trusted network, and thus, electronically coordinating services together around shared clients and outcomes.

At Unite Us, we are driven by our mission to help people – it’s baked into everything we do. As we shared in TEDMED, “Imagine a world where people have access to quality care and services, regardless of socioeconomics, race, or zip code. In that world, everyone would have the opportunity to not only survive, but thrive.” We have a reason to wake up each morning and get to work, knowing that we are helping people most of us will never meet – but it gives us purpose every single day.

Well before and since COVID-19, the industry was interested in what our leaders had to say about the future of health. Our President, Taylor Justice, was asked to share his expert insight for the New York City Healthcare Venture Capital Report. Since the pandemic struck, our CEO, Dan Brillman, offered a roadmap in HLTH for the industry navigating health and social care service delivery through the pandemic and beyond. Dan and Taylor shared their insights on addressing both community-based and cost-of-care outcomes as well as scaling assistance on a community level in this Covid-19 era in the Outcomes Rocket podcast.

At Unite Us, we always believed that health equity was an integral part of our work, we just didn’t talk about it enough. You’ll be hearing more from us in the weeks and months to come. Know this: we stand with communities of color and will work even harder to ensure that zip codes no longer dictate health outcomes.

We were built for this – and we’re ready for whatever else 2020 has in store. Together, we are stronger. Together, we continue to serve our communities across the country. Regardless of what the world throws at us, we’ll keep building healthier, more equitable communities.

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The post Taking a Moment to Look Back, and Plan for the Road Ahead appeared first on uniteus.com.

What drew you to Unite Us?

Parker: I found that Unite Us’ corporate mission aligned with my own personal philosophy on healthcare: the best form of healthcare is that which not only meets an individual’s medical needs but all their other needs as well.

Wayne: My mother was a social worker for over 30 years and dedicated her life to helping people access resources and opportunities in order to build better lives. Unite Us is a company with many of the values I grew up admiring in her.

Gracyn: Unite Us has a company culture that goes above and beyond what a normal work environment should be. Surrounding myself with people that are so focused on constant improvement and bettering health makes me feel like a part of something important.

Sal: I read a blog post from Steve Strauss, the Head of Network Development at Unite Us and my interviewer. He explained the impacts of the social determinants of health, which I read plenty of related literature in my classes. His nuanced explanation of it and how Unite Us fits in it all gave me an insight into the company. The idea seemed so simple, but the execution has been almost perfected here.

Taylor:The mission and values that the company has really drew me to Unite Us because they align with my values and made me want to be a part of Unite Us’ culture.

Sophie: I took a Community Psychology class this past semester where we mainly focused on how our country’s approach to health and healthcare is all too narrow. Often, the social determinants of health are forgotten, though they are some of the most important pieces to understand and fully resolve a person’s health issues. I was really excited when I learned about Unite Us because it is working to bridge that gap between healthcare and social care – looking at the person more wholly rather than a siloed perspective. The company’s mission aligned with what I had learned about in my class which only furthered my interest in Unite Us. I believe it will one day be an extremely pivotal company in the healthcare field, allowing people across the country to gain better and more efficient access to the resources they need.

What are you studying now?

Joemma: I am currently in a dual degree program pursuing a Master’s in Business Administration at Dartmouth and a Masters in Public Administration at Harvard focused on the business and policy of healthcare.

Parker: I am a dual-Masters’ student at the University of Oklahoma, pursuing an MBA and an MIT degree.

Gracyn: I am currently studying marketing and entrepreneurship at Syracuse University. Social media marketing is what interests me most in the field.

Sal: I’m halfway through a master’s in health administration from the University of Oklahoma.

Taylor: I just graduated from Clemson University where I studied Business Management and I found a passion for Human Resources.

Wayne: I’m a dual major pursuing a Masters in Business Administration and Management Information Technology from the University of Oklahoma.

Sophie: I’m studying Marketing and Psychology and I’m hoping to learn more about exactly how those fields intertwine.

What are you hoping to learn about while you’re here?

Gracyn: So far, I have learned so much about growth and how a company can start from an idea and prosper into something much larger than that. Coming into this, I knew little about the healthcare industry itself, but after only a few weeks I have come to understand the impact that Unite Us has and the importance of moving from a system based on volume to one based on value.

Parker: My time with Unite Us as the finance and legal intern has provided me lots of opportunities to learn more about the financial planning and legal thought process that goes into running a business. I am hoping to combine this understanding with more experience in performing data analysis and strategic planning.

Joemma: This summer, I am excited to deepen my understanding around the delivery of social determinants of health and how technology can help support the delivery of social care.

Sal: I’m hoping to learn how to conduct market research, how to deliver pitches to these organizations, and have a deeper understanding of how health systems address social determinants of health. Currently, I’ve learned plenty about the Massachusetts DSRIP program, which is trying to move accountable care organizations in the Massachusetts market to value based care in order to save on overall cost of care.

How do you plan to apply what you learn to your career?

Sal: I’m learning about how organizations tackle social determinants of health, which can be vital in reducing total cost of care over an entire patient population base. This is the future of American healthcare as we move towards a more value-based care system. I don’t know what the future holds for me, but I plan to work in hospital administration. I’ll use what I learned at Unite Us to create programs to address those issues, and I’ll have a unique approach to it.

Joemma: I hope to continue to work in healthcare and technology after I graduate and I think the knowledge and skills I gain at Unite Us will be invaluable to achieving this goal.

Gracyn: Throughout this internship, I plan to learn about what factors lead to success in marketing and how to utilize different platforms to reach target populations. In doing so I can take what I have learned and use it to make a difference wherever I end up in my career.

Parker: Unite Us is in a stage of high growth and quick change, and through it all I have been encouraged to work hard, enjoy my time here, and think better. I believe these are three core values I can apply to my career no matter what industry or company I work in.

Taylor: This has been a hands on learning experience and everything that I have learned so far is so important. I will take my knowledge and new skills with me to continue and achieve success throughout my career path.

Sophie: I’m not sure what career path I intend to take, but Unite Us has given me invaluable experience working in a fun but hard-working environment where everyone shares the common goal of moving the company forward, and in turn, healthcare in general. I have learned how to adapt to an ever-changing agenda in order to meet our current needs, requiring quick thinking and versatility. I will absolutely take those values and skills with me wherever I end up later.

Wayne: No matter what sector of business I ultimately end up working in, success will be determined by business decisions. Watching a company go through a period of rapid growth and participation in important discussions is invaluable and a great opportunity to learn.

We’re so proud of this class of interns and how much they’ve already achieved in their short time here. We love watching you all learn and grow; we’ve learned a lot from you, too. We hope that each of you continues to follow your passions, surround yourself with people who support you, and accomplish all your personal and professional goals. Thank you for choosing Unite Us!

To learn more about working at Unite Us and see how you can get involved, click here:

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The post Meet our Summer 2019 Interns appeared first on uniteus.com.

Today, I want to talk about why we do what we do.

It’s no secret that navigating the health and social sectors in this country is challenging, even for the professionals working in them. There were a number of factors that drove us to want to solve this issue. Our founders and I saw organizations across communities struggling to do the jobs they were specifically trained to do while trying to do more and more to ensure their clients got what they needed. We felt the struggles our fellow Veterans and service members were experiencing once they transitioned out of the military and couldn’t find even the most basic resources like transportation and housing. This is when we said, “The system is broken, but as a community, we can fix this.” This is when Unite Us was born.

We know how important it is to address peoples’ individual needs, and we know that this requires a wide range of programs and specialties – from organizations delivering medically tailored meals to diabetes prevention programs to emergency housing assistance. That means stakeholders from different sectors have to work together to truly improve people’s lives.

Complex human needs can’t be solved with software alone. Connecting providers together is just the start.

Every person has their own story and every community has its own history. It’s in our DNA to understand your community’s strengths and weaknesses. Are certain populations slipping through the cracks? We’re continually improving a system in which the people expected to deliver services across the continuum of health are actually given the resources they need to do so. What would happen if the proper technology was in the hands of every person trying to collaborate around individuals seeking care? We set ambitious goals, and we’ve met them by starting local.

Unite Us can’t take credit for being the conveners in every community. We don’t replace the people in your community who know it better than we ever will. We’re here to build them up and empower them. What we bring to the conversation is years of expertise building accountable networks in different communities across the country and the secure technology that facilitates screening, electronic referral management, bidirectional communication, and transparent outcome tracking for people delivering every type of care. We know what’s required to keep partners engaged in our networks. Perhaps most importantly, we know that our approach works in successfully connecting people with the resources they need.

There are numerous structural and cultural discrepancies between clinical and community practices and metrics. As it stands today, linking these two sectors with technology accounts for the structural component. However, we’ve learned that we need to supplement technical interoperability with genuine human-to-human connection and understanding in order to drive real, lasting results. In the same way that our community engagement process can’t be described with a simple equation, the data each provider singularly collects cannot tell the full story about someone’s life. There are parts of our health that can’t be measured with a stethoscope, thermometer, or scale. We now know how to measure the effect of SDoH interventions. What’s next is to continue shaping how we integrate medical care and social care, drive innovative payment models incorporating social services, and help push policy to truly transform communities.

Partners in a cohesive delivery system need to work together; this means going beyond identifying shared goals and sharing information.

As a connected community, we have to continually follow up on actions we’re taking and progress we’re making. This also means giving people the support they need to effectively play their part in the partnership. We believe that when an individual’s entire community care team has visibility into all of the factors that impact their health, they are able to help them better and faster. Unite Us puts this theory into practice in more communities every month.

We’re guided by our mission to help people receive the services they need, and we’re doing this by empowering the people delivering those services. Every single member of the Unite Us team is committed to making our partners’ jobs easier. To all our amazing network partners, old and new: thank you. Thank you for working tirelessly every day to help real people with real problems. Thank you for believing in the power of collaboration and disruptive innovation. Together, we are changing the world and people’s lives, and we couldn’t do this without you.

Thank you for believing in Unite Us.

Dan

To learn more:

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The post A Letter from Our CEO appeared first on uniteus.com.

Shadi is the Partnership Marketing Manager here at Unite Us. She recently joined the team at our New York City headquarters and is excited to collaborate with our rapidly expanding group of network partners.

Throughout my life, I’ve always sought out ways to merge a passion for people with a passion for impact. The opportunity to join the team at Unite Us was an ideal situation, with their mission-driven approach centered at the core of the company. While I never could have predicted it, the decision to work at Unite Us was one of the most certain I have ever made.

I had my first exposure to the health and human service field in college, thanks to a bachelor’s degree in Human Services. Centered in social justice, this was a transformative experience rooted in empathy and understanding. As immigrants, my family and I certainly didn’t have the easiest time building a new home, but my degree helped me realize the extent of my privilege as we were guided through the process by family and friends. Sometimes, one of the best effects of school is realizing how much more there is to understand. I was determined to learn even more about the world around me.

This curiosity led me to New York City to pursue a master’s degree in International Affairs. While my experience in graduate school was undeniably valuable – absorbing thought-provoking textbooks and engaging in spirited debates with classmates – the city served as an equally important teacher. NYC gives you a global perspective, as thousands of identities and cultures cohabitate together. Case in point: the subway can be one of the greatest equalizers as we all commiserate on commutes and celebrate cute babies and dogs along our routes. The subway can also show harsh realities of inequality in the city as neighborhoods drastically change from one stop to the next. The connections between social, economic, and environmental factors that influence our health become all the more visible throughout different neighborhoods.

As my worldview expanded, so did a desire to help facilitate impact. At first, I wasn’t exactly sure where my skills fit in, but thankfully a complementary path had been forming all along through marketing. In my college days, I helped build a variety of online communities to support music, art, and non-profit spaces. Then, in New York, the agency world showed me how digital marketing could influence large audiences. It is always so exhilarating to see the direct correlation between online and “real-life” support. Marketing has been my ultimate tool to build bridges and engage communities. As the world becomes increasingly interconnected, an active digital presence is crucial.

At Unite Us, I look forward to creating marketing content that showcases the impact of our networks as they continue to expand and grow. I’m so excited to work closely with our amazing Account Managers, Community Engagement Managers, and network partners and shine a light on their important work. Just as Unite Us builds coordinated care networks of organizations across the continuum of care, I will develop networks of digital communication to connect and amplify the stories that matter from a local level.

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My path to Unite Us has crossed multiple areas of the health care sector but has always been rooted in the fundamentals of public health… more specifically, the desire to impact the health of my community in a positive way. With a graduate degree in public health under my belt, I was seeking an opportunity to immerse myself in the public health landscape in New York City and to address the larger issues in our communities – issues rooted in the social determinants of health. I then found Unite Us, which not only provided me the opportunity to serve as I had hoped but also presented a nuanced approach to care coordination with an outcome-focused perspective on the communities it served.

Before joining the Unite Us team, I got a glimpse into care coordination from a slightly different perspective. While I attended graduate school, I completed an internship in the Patient Experience department at a local hospital in my community. The department was established with consideration to the Value-Based Purchasing Programs, led by the Centers for Medicare and Medicaid Services. More specifically, one of the department’s main foci was on the Hospital Readmission Reduction Program (HRRP), which was centered upon connecting recently discharged individuals to resources in their communities in order to reduce the number of readmissions and unnecessary emergency service utilization. The department sought to find what could’ve improved a patient’s experience while they were admitted, as well as what resources would be most beneficial to offer discharged patients so they could manage their care.

My role in the Patient Experience department was to analyze data gathered from Post Discharge Follow-Up phone calls, which collected information on what resources individuals required to ensure a smooth transition from hospital to home care. Many of these questions focused on the individual’s knowledge of community resources, and whether or not they planned on utilizing them post discharge. Using these responses, I compiled a Community Resource Manual for the department, listing useful community resources catering to physical health needs, social services, and other holistic health services. If and when these services were needed, the department would connect the discharged individual to services closest to them, or those pertinent to their needs.

Although this approach was an asset in terms of linking patients to services in their community, it lacked transparency to their trajectory of care, and whether or not they had a positive outcome from utilizing those services. It also placed most of the responsibility on the patient to manage their own care and navigate their communities for services they were eligible for. In my experience, I felt like we were making strides to solve these issues, but with limited insightinto the resolutions of the patients’ problems.

Unite Us shares a similar mission of connecting individuals to community resources but goes beyond the traditional “referral” method by providing an outcome-focused, personalized approach. This method goes beyond the traditional resource directory to the root of public health issues, addressing all determinants of health and tracking the outcome of each client who receives services. With the emphasis on prevention and outcome, this approach exercises two of the main facets of public health initiatives – creating a robust and overarching method of coordinated care.

One of the main themes at Unite Us and a part of our mission that we pride ourselves on is to “close the loop” on the care that is delivered to our community. This means establishing a sense of transparency in an individual’s care trajectory while emphasizing the importance of determining an outcome in case management. These invaluable aspects of Unite Us set our software apart from many other referral and case management workflows. In my own personal experience, I see the opportunity to be a part of the Unite Us team as “closing the loop” in my own career path by experiencing care coordination in a similar setting – now going one step further to streamline that effort through an innovative technology platform.

To learn more about how Unite Us takes care coordination to the next step:

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The post Closing the Loop in My Care Coordination Journey appeared first on uniteus.com.

Unite Us now operates 48 networks in over 20 states. We’re setting a blueprint for communities across the country, and we’ve learned countless lessons along the way. If you’re looking to address social determinants of health or fix the gaps in your community’s care, now is the time to start.

Lesson One:

If you focus on outcomes, you’ll build the right infrastructure.

At Unite Us, our true north is: “Can I prove that each client has received the services they need?” We obsess over end results. To be able to answer this question properly, we need to build the entire supply chain – making sure we map every workflow from each client’s initial engagement to their final resolution. For years, when health, human, or social service organizations considered social determinants of health solutions, they only answered the question, “Where are the resources?” This created a focus on resource directories. But instead of thinking about the next step after identifying resources, the curiosity stopped and organizations were just handing out lists of services to people. Needless to say, this is not a sustainable solution. To truly drive outcomes, we have to do the hard work upfront, and not just hand off tech to users or expect it’s purchasers to handle change management or implement your product themselves. That’s not their job; that’s where a technology partner comes into play.

Lesson Two:

This is about people, not just the technology.

Technology isn’t a silver bullet. It’s a tool. Our goal is to leverage tech that allows humans to connect with other humans in the most efficient way possible. Understanding the pain points of a social worker, a community health worker, a 2-1-1 operator, etc. has been crucial to driving users’ adoption of the tool, which will drive the success of a coordinated network. Technology is useless if no one adopts it, so we take time to show the value of our tool for each of our users. This is how we empower them to make a greater impact in their community while lightening their workload.

Lesson Three:

Models don’t work; processes do.

No one likes to be told what to do. It’s human nature. Any time you try to roll out a new model, be prepared for: “Oh, your model worked in X, Y, Z community? Well, my community is different and it won’t work here.” While there is some truth in this statement – every community is different – this is exactly why you must have a fluid process that can push levers up and pull levers down as needed based on local politics, local personalities, and local workflows. There is no one-size-fits-all solution when it comes to community care. The service category titles (employment, housing, transportation, food, education, etc.) are all the same in every community, but the people managing them aren’t. Look back at lesson number two: this work is about people. People are constantly changing. Listen to them, understand them, and facilitate a process to implement a coordinated network. Don’t just try to implement an off-the-shelf model.

Lesson Four:

No organization should have priority over another.

Health systems and health plans have larger budgets than community-based organizations (duh). However, to effectively address the social determinants of health in communities you must bring human and social services to the same priority level as healthcare. Just as a health system will require integration with their electronic health record (EHR) vendor because they don’t want their staff logging into numerous tools, we must also make the same consideration of the human and social service providers. People only working within their own silos is how we got into this mess of fragmentedservice delivery in the first place. Flip your view of the world to focus on the community-wide care coordination network and how well health, human, and social organizations fit into that. When organizations break down these invisible walls, it allows them to see holistic patient journeys both inside their own facility, and more importantly, outside their facility and across the continuum of care.

These are just four of many lessons we’ve learned over the years and by no means a comprehensive list. These arebasics that can help any community set the stage and frame the conversation about how to build a community-wide care coordination network. These foundational principlesshould help facilitate harder discussions around security, privacy, data rights, evaluations, outcome standards, and more.The message I want to emphasizehere issimple: no one person, no one organization, and no one technology platform can solvethe gaps in community care alone.

To learn more about how Unite Us is coordinating care across sectors:

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The last three years of my professional life have seen my career as a creative storyteller grow into something more than just a hobby. I have had the distinct honor of working with amazing brands, organizations, schools and artists to tell their stories through the lens of a camera. The theme of storytelling has become something that means more than just words on a page to me, but now I understand the power and privilege that comes along with the camera; a privilege that we aren’t all so lucky to have.

Arriving at Unite Us in November of 2018 was somewhat of a dream scenario for me. Building upon the career path I had started at Shoots Media, I was given the opportunity to move into a space that had a very unique story to be told. Before I could really put my foot to the pedal at Unite Us, it would be imperative to familiarize myself with the narrative surrounding the social determinants of health and all of the major players looking to influence the space. What was immediately astonishing to me was the lack of easily consumable content (or maybe just the overwhelming amount of dense scholarly pieces from big name research organizations). One month later, and hundreds of articles read, I understood two very crucial realities: there wasn’t enough educational content for the masses and there was a massive void with regards to visual data representation. In my eyes, my viewpoint changed from, “we must tell the story” to “we must tell the story in a way in which we can all enjoy and understand.”

With this revelation fresh in my mind, the gears have started to set into motion. There is a blank canvas in front of me, and with a camera and lens I believe that a beautiful image can be created – one that can begin to shift the tides for health andhumanservices, one that can be consumed by clinicians, community health workers and patients alike. By pairing video with the rest of our team’s existing content stream, I hope to achieve this goal by adhering to the following three rules:

1. Consistent Scheduling – While there is no argument over the power of video content, the strongest pieces build off of consistent scheduling. Whether it is daily, weekly or monthly segments, creating a continuous dialogue with your audience begins to build an interactive relationship where both parties can expect loyalty in exchange for content.
2. Consistent Message – Along with a constant stream of high-quality content comes with a consistency of tone, theme and subject. Unite Us continues to push itself as an industry thought leader on all fronts, and maintaining this stance using our provocative yet informative tone in video will only help to spread our message.
3. Striking Visuals – It goes without saying that a powerful image can have an almost magical ability to invoke certain emotions. Paired with the stories of hardship, perseverance and positive outcomes from our clients, visuals of human touch will work wonders to instill a feeling of obligation to move the needle.

My viewpoint changed from, “we must tell the story” to “we must tell the story in a way in whichwe can all enjoy and understand.”

To be given the opportunity to work for a company like Unite Us while building upon a passion of mine is something that I am extremely proud of. Not only do I get to continue to develop my craft, but I am doing so in a manner that will directly combat some of our nation’s most significant shortcomings. By giving a voice to those who need it most in the communities that Unite Us works to empower, I plan to work together with my team to effectively address the social determinants of health into 2019 and beyond.

The post A Story to Tell: My Journey to Unite Us appeared first on uniteus.com.