In PCIC's three years of serving clients with complex needs, we have learned that no single entity has the data or influence to build an effective, cross-agency care coordination program.

We believe that to enact a more functional health safety net, community leaders from social, governmental, legal, and medical agencies must join forces to share data and build lasting solutions.

While this may seem lofty, it's not out of reach. Many pieces are already in motion to pilot a data-driven community health council in Houston, TX, and PCIC is leading the way in building data-sharing infrastructure between provider systems.

Establishing a focus group for stakeholders

PCIC recently received grant funding to support a partnership with IMAGO Global Grassroots, an affiliate of Harvard’s Kennedy School of Government, to provide guidance on how to effectively create and run a high-level community focus group.

To begin, PCIC is collaborating with the Houston Recovery Center to expand upon a community forum framework (The Care Coordination Planning Team) that is already in place.

Visualizing where and when people with complex needs access resources

PCIC’s Unified Care Continuum Platform links over 8,000,000 patient records from social and medical agencies.

By analyzing resource utilization trends over time, PCIC can identify which community programs directly reduce frequency and cost of hospital admissions, EMS calls, homeless shelter check-ins, and more.

Stay tuned for updates by subscribing to our newsletter and/or following us on social media!