Community Care Team Training Symposium
How to Develop Community Collaboratives to Address Social Determinants of Health in High-Risk Populations
Community Care Teams (CCTs) create multi-agency partnerships to link those with complex medical, mental health, addiction and social challenges to needed services.
9 am – 4 pm
Please plan to arrive at 8 am for check-in and breakfast.
Robilotti and Creasy Auditoriums
24 Hospital Avenue
$75 per person
Breakfast and lunch included
Learn from the successes of Western Connecticut Health Network’s CCT originators how to link high-risk individuals to appropriate services using a cost-effective, data-driven population health model to improve healthcare stability and decrease emergency and acute care utilization.
Rowena Bergmans, Vice President, Clinical Integration and Population Health, WCHN
Ms. Bergmans is currently serving as Vice President of Clinical Integration and Population Health for Western Connecticut Health Network (WCHN). Her responsibilities include overseeing the Physician Hospital Organization (PHO), whose membership includes Danbury, Norwalk and New Milford Hospitals along with 1021 providers. In addition, she is developing and implementing accountable care strategies for the Network in an effort to align community needs, operations and business models with changing healthcare policy and funding streams. She joined WCHN after serving as Vice President of Medical Affairs for Clear One Health Plans of Bend, Oregon where she oversaw all health-related services and programs includingdeveloping community solutions to address the current challenges facing our care delivery system.
Katherine Tait Michael, MD, Medical Director, Community Health, WCHN
Dr. Michael is a board certified psychiatrist with more than 20 years of clinical, administrative, consulting and teaching experience. She served as Chairman of the Department of Psychiatry at Norwalk Hospital and is now Medical Director for Community Health at Western Connecticut Health Network. Her work has included creating, implementing and managing community care teams; integrating behavioral health into primary care and using Tele-health strategies to better care for those with chronic medical, mental health, substance use and social needs. She is on the active medical staff at Danbury, Norwalk and New Milford Hospitals.
Keynote Speaker – Brian D. Smedley, PhD, Co-founder and Executive Director of the National Collaborative for Health Equity
Dr. Smedley is Co-founder and Executive Director of the National Collaborative for Health Equity, a project that connects research, policy analysis, and communications with on-the-ground activism to advance health equity. From 2008 to 2014, Dr. Smedley was Vice President and Director of the Health Policy Institute of the Joint Center for Political and Economic Studies in Washington, DC, a research and policy organization focused on addressing the needs of vulnerable populations. Dr. Smedley’s expertise includes racism and health inequity, social determinants of health, healthcare disparities and diversity in health professions.
Addressing the Impacts of Social Determinants of Health on High-Risk Populations
Social Determinants of Health (SDOH) include issues such as housing and food insecurity, environmental safety, economic stability, access to education and adequacy of community supports. These “determinants” have a far greater impact on health outcomes than do direct medical services. As a result, programs that address SDOH are necessary to improve the overall wellness of communities.
CCT Leaders – Successes and Challenges
The WCHN CCT team will share their experience in building effective, sustainable clinical and financial frameworks to engage multi-sectors to meet the needs of high-cost, high-need populations. Gain critical knowledge on how to actively engage community stakeholders, successfully break down silos and use data-driven decision-making to reduce costs, improve patient outcomes and enhance the lives of your most vulnerable community members.
As with any program, there are challenges. From this discussion you’ll gain valuable insight on how to effectively manage challenges such as developing a standardized patient consent to share among community partners, learning techniques to motivate and sustain group attendance and engagement, defining the CCT Navigator’s role within the hospital and navigating patient care from the inpatient setting to the community.
(Each participant will be given the opportunity to attend two break-out sessions. Please select the two sessions of greatest interest):
Operations: Tools and Processes for Success
Attendees will be guided through the business planning process of building a CCT from design and structure to performance measures and impact necessary to ensure success. This session will highlight the infrastructure framework needed to build a successful collaboration that focuses on engaging multi-sectors to benefit and meet the needs of vulnerable populations.
- Identify essential elements that contribute to launching a successful CCT
- Keys to building a strategic financial and clinical framework
- Short- and long-term goal planning
- Create a Release of Information
- Describe CCT staffing needs
- Identify key stakeholders from hospital and community settings
- Develop a usable patient tracking system
- Review use of individualized care plans including electronic charting
Sustainability: Funding CCT Operations
Learn the keys to building a sustainable model for success by leveraging multisectoral collaboration to overcome limited investment funding. This session will engage participants in a discussion of what makes cross-sector teams effective in addressing big needs and the benefit of leveraging partnerships to build capacity. Overcoming limited economic and resource barriers will be discussed.
- Discuss funding sources such as grants, foundation and hospital support, philanthropic investment and other creative ideas to generate funding
- Establish financial goals for sustainability
- Gain support from Senior Leadership
- Review financial needs for staffing and outreach services
- Discuss structure for Board oversight and governance
- Effectively utilize multi-sector partnerships
- Advocate for continued support
Measuring Impact: Data Collection, Analysis and Reporting
This breakout session will outline the use of data to develop a collaborative approach to address social determinants of health, reduce health disparities and improve wellness. Learn how to build meaningful connections between traditional healthcare and non-traditional community stakeholders to achieve meaningful, data-informed outcomes. Participants will understand how this person-centered approach can achieve a return on investment through improved outcomes and reduced avoidable inpatient hospitalizations, emergency room visits and ambulance transportation.
- Identify CCT goals and outcomes that align a hospital’s business model with community engagement strategies
- Discuss data integration for the development of an implementation plan that includes strategies for building successful partnerships that will translate into enhanced care
- Identify methods of tailoring data collection to meet population needs
- Understand the data and utilize metrics to drive goals/outcomes
- Share successes and challenges
- Identify measurement standards
Building Vital Partnerships: Community Agencies and Hospital Collaborations
Don’t reinvent the wheel! Participants will learn how to bring together partners from multiple sectors and leverage assets critical to improving health outcomes. This discussion will outline how to build partnerships with key stakeholders to address the socio-economic factors and unmet needs of high-cost, high-need populations. Stakeholders range from medical, mental health and addiction treatment providers to municipal social service and public health agencies. Participants will learn how to build lasting, effective partnerships to achieve meaningful, data-driven outcomes.
- Identify key hospital and community stakeholders
- Determine shared goals and discuss building robust, effective partnerships
- Develop strategies to break down silos
- Learn how to engage in likely and unlikely partnerships
- Define roles and responsibilities
- Discuss the role of Peer Recovery/Engagement Specialists
- Plan for the long-term – look beyond immediate needs and expand partnerships to address other population needs
- Develop structure for ongoing communication, collaboration and engagement to meet overarching CCT goals and patient needs.
We are currently experiencing difficulty with our registration page. Please email WCHNCCT@wchn.org with your contact information and we will follow up with you shortly.
We apologize for any inconvenience and look forward to your attendance at the symposium.
Western Connecticut Health Network is an approved provider of continuing nursing education by the Northeast Multi-State Division, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
Western Connecticut Health Network is accredited by the Connecticut State Medical Society to provide continuing medical education for physicians.