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On October 5, 2020 Theresa West, Vice President Community Solutions at Signify Health, and Donna Wilson, Community Health Manager and Traci Spillman, Community Network Program Manager at Mosaic Life Care participated in a panel discussion at The Root Cause—Fifth National Summit on the Social Determinants of Health. They were joined by Linda Judah, Executive Director at Social Welfare Board for the presentation “The Elephant in the Room Preventing Collaboratives from Achieving SDoH Outcomes: Privacy. What It Takes to Build a Safe-Sharing Community Network.” Their presentation, summarized here, gives an insider’s look at what it takes to build a community network optimized for outcomes. 

No one person, program or organization can improve community health outcomes alone. It takes an entire healthcare and community team to build a “safe-sharing” community network that can effectively tackle the complexities of healthcare and its contributing social determinants of health. 

The term “safe-sharing network” is purposeful. It requires a technology platform that connects all the health and social services partners in a way that honors the privacy and dignity of the individuals being served, while also permitting the right people to see the right information at the right time. 

Protecting privacy while sharing information is one of the most challenging barriers to building a safe-share community network. Once you move beyond the walls of a healthcare system, you move beyond HIPAA and into an even more complex privacy system of State and Federal privacy laws that includes FERPA, State Family Codes and Laws, as well as privacy requirements on sensitive subjects like substance use disorder, HIV/AIDS, behavioral and mental health and domestic violence. 

Safe-sharing network cornerstones
Creating a safe-sharing community network that complies with complex privacy protection laws requires three safeguards:

1. A technology platform that has an informed-member consent and permission-based privacy structure built into the system, where individuals only sign one consent form.
2. Signed BAA/data-sharing agreements with all the organizations in the community network--both covered and non-covered--so they can safely share the information necessary to help their clients. 
3. Finally, a system that protects special information in accordance with State and Federal laws and regulations so only the person sending and the person receiving sensitive information can see it. Everyone else in the community network has access to the other information that they need to care for their client.

When using a safe-sharing network, an individual signs just one consent form and does not have to repeat their story multiple times. A safe-sharing network not only improves health care and social services collaboration and coordination; it also builds a longitudinal whole-health record, both clinical and social services care. This record includes:

• Demographics updated
• Assessments performed
• Needs identified
• Referrals shared
• Services provided
• Meaningful outcomes

Every single step and data point becomes part of the whole person care record, creating a true longitudinal record where social data and clinical data merge together. Shared longitudinal records support consistency among community partners because every organization is working with the same client assessment, process and accountability for level of care. 

These longitudinal records enable real-time collaborative decision-making among both clinical and non-clinical providers. At the same time they provide a collective view of a client’s clinical and social services needs so network organizations can more easily identify gaps within the individuals care plan.  

Why it matters
Building a safe-share community network allows the community to combine privacy compliance requirements with a streamlined consent process; increase the collaboration within their clinical and community organization network; share true longitudinal records; and, more easily identify a client’s gaps in care. It is a pivotal step in tracking and improving outcomes by integrating clinical care while matching community resources to a client’s social determinants of health needs. 

This increased capability to share information improves not only the consistency, collaboration and partnership among the safe-sharing network of clinical and social services; but also, instills accountability and improves the overall quality of care and client outcomes. With this level of data sharing and collaboration, these networks can take real time action that has a true impact on local communities and the people being served. 

Consider this situation. A young mom and her newborn baby girl go into the clinic at the Social Welfare Board for the newborn’s one month check-up. After conducting a screening, the caregiver identifies that the mom is no longer working. While she can take care of her newborn, she has no maternity leave or vacation and is struggling to pay her utilities and rent, has very little healthy food, and is suffering from depression. It’s about more than sympathy, it’s about solving an immediate need by taking action! 

The caregiver becomes the first domino in the solution chain and takes immediate action by referring the young mom to a variety of local community and clinically-based organizations to help address her social and health needs. The community partners carefully hold the young mom and her newborn at the center-of-care as they collaborate in real-time to solve her needs. Their goal is to ensure that the young mom and her newborn have the care and resources they need to thrive. Having a safe-sharing network allows everyone involved in this young family’s care to work as a team focused on helping them access the care and services they need when they need them. 

Mosiac Life Care is a real-world success story of how organizations can turn their town into a team by creating a safe-share community. See how they built a network with the ability to share real-time information to improve their community health outcomes.