The Collaborative to Advance Social Health Integration: What we’re learning about delivering whole-person care

Supported by Health Leads and The Commonwealth Fund, the Collaborative to Advance Social Health Integration (CASHI) was a community of 21 innovative primary care teams and community partners committed to increasing the number of patients, families and community members who have access to the essential resources they need to be healthy. This was accomplished through focused efforts to improve social health practices, spread them to additional sites, and work toward financial sustainability plans.

More broadly, CASHI was created to develop implementation guidance in areas where social health integration know-how was limited but critical for effective delivery of whole-person care. We intentionally set an ambitious agenda and chose teams willing to innovate in varied areas of the program. CASHI focused on four core areas: Accelerate practice on key drivers of health equity including patient/community engagement, community health worker (CHW) integration and support, and cross-sector collaboration. Test patient-reported outcome measures (PROMs), which are required to measure social health impact, but difficult to collect and report. Plan for financial sustainability by creating an enduring and practical process for business case development. Move beyond pilots to spread essential resource navigation as an integrated part of care across many sites.

Each team developed aims with specific targets for their organizations and shared progress along the way. Here is what we achieved and learned together.