Advancing Integrated Models - emerging insights from a multi-site demonstration focused on implementing "next-generation" approaches to person-centered care for individuals with complex health and social needs.

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Introduction:This interactive panel will engage participants in emerging approaches and lessons learned from integrated models promoting innovative, person-centered strategies to improve care for adults and children with complex health and social needs. It will describe approaches that prioritize individuals’ lived experience and community needs within a variety of health care settings and share challenges and opportunities to assist others in incorporating these approaches in their own environments.Background:Health-system-led efforts too often remain disconnected from the communities and social contexts in which their patients live. They are particularly disconnected from people who have experienced trauma and face complex health and unaddressed social needs, such as a lack of stable housing, food insecurity, and repeated exposure to violence. Yet they have tremendous potential to be vital partners in addressing health-related community needs and disparities -- from clinical care access and quality to housing, jobs, and food security. To improve health outcomes and foster health equity for individuals with complex needs, a small but growing number of leading health care systems are testing more holistic, person-centered approaches for delivering medical, behavioral health, and social services. These include integrated strategies to: address physical, behavioral health, and social needs; advance a trauma-informed approach to care; authentically collaborate with community partners; and recognize the role of race, power and privilege in driving health outcomes.Aims and objectives:• Share emerging approaches to more effectively deliver integrated, person-centered care to individuals with complex health and social needs.• Problem solve key challenges in authentic community engagement and addressing power imbalances at the individual, institutional, and community levels.• Share relevant resources to support health care providers in advancing care delivery that is more integrated, person-centered, and guided by the community served.Target audience:• Health, social service and behavioral health providers; community advocates; policymakers; payers; funders; researchersLearning/takeaways:• To be person-centered, integrated care must take into account the full context of individual and community experience.• Trauma-informed care and explicit efforts to acknowledge and address race, power and privilege are increasingly viewed as essential to a person-centered approach.• Investments of time and resources to build relationships and establish trust between communities and care systems are critical to address power imbalances and achieve better population health.• Promising strategies are emerging in an array of community settings that may be worthy of replication. Format- 60 mins:• Interactive moderated panel starting with an overview of programs that deliver integrated, person-centered care to individuals with complex health and social needs- 10 minutes• Complex patient vignette - 5 minutes• Program managers’ discussion of two innovative trauma-informed examples of health system transformation to integrated and person-centered care incorporating community voice and key challenges to implementation including (1) adopting a trauma-informed approach, (2) incorporating individual/community voice and decision making in program design, (3) engaging with community partners, and (4) addressing racial/ethnic/religious discrimination within the health care setting: 30 minutes;• Revisiting the patient vignette and program approaches to address challenges: 5 minutes;• Questions 10 minutes