The Delta Region Community Health Systems Development (DRCHSD) Program provides community care coordination (CCC) planning and strategic technical assistance to all program participants — with the goals of aligning local services with community needs, improving health outcomes, and addressing social determinants of health.
The three-year-long CCC planning and implementation process establishes a comprehensive foundation to enhance care coordination efforts by developing and strengthening partnerships between providers and community partners. DRCHSD Program staff offer step-by-step guidance on how to plan, create, implement, and sustain successful collaborations between health care organizations and their community joint partners. This approach helps to build and strengthen a community’s capacity, create partnership buy-in, establish accountability, and assist all of the involved organizations in creating a plan for sustainability.
DRCHSD Program participants each hire a Community Champion to assist in this work. The Champion takes the lead in carrying out CCC planning and implementation in their community, with the support of and guidance from their organization’s leadership and DRCHSD Program staff.
DRCHSD Program Approach to Developing and Strengthening Community Care Coordination Services
Step 1: Build a foundation to identify and connect with diverse community joint partners.
Step 2: Collaborate with community joint partners to identify and address community and patient health needs by maximizing capacity and available assets to improve transitions of care.
Step 3: Monitor progress, strengthen collaboration, and strategize for ongoing self-sufficiency and sustainability to ensure diverse and vulnerable populations benefit from coordinated care.