One Health is a program designed to meet the needs of our uninsured, medically and socially complex patients. The goal of the program is to improve the health of our most vulnerable, while bending the cost curve. Complex patients comprise a small, heterogeneous group of individuals who frequently cycle through multiple systems (healthcare, behavioral, social, correctional), but do not receive any lasting benefit from the interactions. Care is often fragmented and systems are rarely designed to meet the needs of the most complex. Hospitals alone are insufficient to meet the complex needs of these patients. A new mindset for building authentic partnerships was required. The team built authentic relationships with cross-sector community partners based on data and trust. New tools were developed and implemented for community asset mapping, model design, and data collection, which led to the creation of a new ecosystem of care inclusive of healthcare, behavioral health, and social services. Additionally, new methods of cross sector collaboration were introduced. Over the course of 27 months, 430 individuals were enrolled. Improved outcomes were achieved in health, housing, utilization, cost, benefits, food security, and self-sufficiency.
The College for Behavioral Health Leadership
Where behavioral health leaders collaborate to grow and transform communities across the nation.