Linn County care coordination initiative pivots to new platform

CEDAR RAPIDS - My Care Community, the public health-led partnership of dozens of area health care and social service providers, is pivoting to address the ongoing factors seen during the COVID-19 pandemic.

Most recently, the initiative identified a new, secure platform to facilitate information-sharing and client referrals across service providers. The new platform is called Unite Us, and is the same platform that powers the statewide network of health and social service providers called Unite Iowa.

“We spent a considerable amount of time studying technology platforms in our community and across the nation, and this was something most inclusive and cost effective,” said Cindy Fiester, Linn County Public Health chronic disease services coordinator.

Background

My Care Community is a countywide initiative that aims to improve residents’ overall well-being through care coordination across service providers. For the majority of those providers, their programs and services address social determinants of health.

“Sixty to 80 percent of factors that influence a person’s health outcomes are related to structural or social determinants of health, and not the medical encounters they have from time to time, such as a primary care doctor visit or a stay at a hospital,” Fiester said.

That includes the air they breathe, the water they drink, their employment status, their access to health insurance and many other factors that can affect overall health.

“In our work, we have acknowledged this and worked with many of our community and health care partners to figure out how to address unmet structurally and socially determinate of health needs,” Fiester said.

The project was first launched in 2016 through a three-year, $250,000 grant awarded to Linn County from the federal Centers for Medicare and Medicaid Services.

My Care Community uses an electronic system that shares patient information with the roughly three dozen health care providers and nonprofit social service agencies involved.

By sharing this information, these agencies hope to better streamline clients’ access to services, without requiring them to provide documentation or share their story multiple times, Fiester said.

What’s happened since?

To date, My Care Community has connected with about 20,400 people. That includes those who were entered into the system, but then moved away or otherwise never followed up to receive services.

The total number of people who actually requested and received a service through the initiative is 8,804, according to Fiester.

The top needs identified by these individuals include: income support and employment; education; employment preparation; utilities; and housing and shelter.

Fiester said the network did see a drop in use during the first eight months or so of the pandemic.

COVID-19 affected providers’ work vastly, forcing them to deliver services in a virtual or socially distanced way. As a result, the partnership saw a downturn in individuals entering care coordination.

With the new Unite Us system, face-to-face interaction will no longer be necessary to ensure people can access services across the partnership, Fiester said.

That’s particularly important as the county continues to address the needs of residents from the August 2020 derecho and the pandemic.

“The two things we’ve experienced most recently were very challenging. Not only did they impact a population in need, it impacted the entire population,” Fiester said.

Comments: (319) 398-8469; michaela.ramm@thegazette.com