Policy & Practice | Spring 2023

technology speaks

By David Gruen

Shifting from Health Systems to Systems of Health: Embracing Technology Upstream to Address Homelessness

M eet Jessica. She lives in Sonoma County, California, and has been diagnosed with several mental health disorders. Like many in her position, Jessica struggles to consistently take medications and keep health appoint ments. She loses her housing, struggles with substance use, and gets arrested on felony arson charges. She’s incarcer ated and found incompetent to stand trial. Homeless, unwell, and in jail, what happens to Jessica next? Much of what we call health care in America—including mental, physical, and behavioral health—is really sick care. It’s focused on reacting to singular events and chronic conditions rather than preventing them. And it completely ignores deep social inequities. Despite spending more than twice as much per person on care than other wealthy coun tries, America’s health outcomes aren’t better 1 —and some are worse. 2 While there’s no magic solution, we can achieve meaningful change by moving more care upstream and embracing technology. By being pro active and preventing rather than reactive and treating, we can shift from health systems to systems of health. I believe that with the right people, using the right technologies, creating systems of health is neither pie-in-the sky dreaming nor glib semantics. Let’s look at Sonoma County, California’s integrated care model through the lens of the Institute for Healthcare Improvement (IHI) quin tuple aim. 3 And watch how Jessica travels through it.

The Challenge In 2018, Sonoma County, California, declared a crisis due to the number of their population that was unhoused. More than 21,000 people faced unstable housing. Meeting the complex needs of this population required more than their existing approach could handle. With support from the Board of Supervisors, Sonoma County formed

a safety net collaborative with health services, human services, community development commission (housing), justice partners, and child support services. They launched the Accessing Coordinated Care and Empowering Self Sufficiency (ACCESS) Sonoma program. ACCESS Sonoma piloted the Merative TM Integrated Care solution,

Photo illustration by Chris Campbell

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