Creating Coalitions of Care

It's said that "it takes a village," and caring for vulnerable and complex patient populations is no exception.

Listen as Dr. Enrique Enguidanos discusses with Victor Murray, Camden Coalition of Healthcare Providers, and Cesar Armendariz, Inland Empire Health Plan, what makes an effective coalition, strategies for getting started, and how communities are pulling together the skilled and financial resources to make these coalitions a reality. 

Transcript

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Enrique Enguidanos:

Welcome everyone to this month's edition of caring, communities, I'm Dr. Enrique Enguidanos, CEO of Community Based Coordination Solutions. And this month's podcast will be focused on creating community Coalition's for complex care patients, I'd like to welcome our two panelists. Cesar Armendariz, Senior Director of Community Health at Inland Empire health plan and Victor Murray, Director of capacity building and community engagement at Camden coalition of healthcare providers, Victor, Cesar, welcome.

Victor Murray:
Thank you. Nice to be here.

EE:
Likewise, thank you. You know, each of you have done great work as individuals and we're going to dive into that but your organization's have each been around for well over two decades now doing great community work and and I thought we might start by just have each of you give us a one to two minute synopsis of the work, your organizations do.

Victor I believe Camden coalition started in 2002, if I'm correct and, and you're leading national efforts now in addressing the needs of complex care patients. Can you give us a little synopsis of how things have evolved and what's going on today.

VM:
Sure. So, the Camden coalition very nonprofit based in Camden, New Jersey, and all of our core work is really focused on working with individuals and supporting individuals with various complex medical and social needs and so these are individuals who have traditionally fallen through the cracks of healthcare delivery systems, and just are not getting their needs met. In as efficient or succinct way. And so we run programs working with individuals everyday in the community, folks who are suffering from addiction related issues, housing instability, mental health related issues, medical issues. We also do a lot of policy work in our region, and in the state of New Jersey, as well as clinical redesign.

And so, you know, we can ask people right what they need to do differently. In order to engage services, but how do or how does, we as a system operate differently in order to meet the needs of people. So working with systems, health systems, both Regional Health Departments county health departments and state to really to provide that service assistance, and then reggae which you alluded to your initial comments was our national efforts. So we realized that you know we're not the only ones entertaining. A lot of these issues in our region. Now our communities across the nation who are dealing with similar challenges, and sometimes not so similar challenges. And so, pulling in individuals partners from around the country to convene, and then talk about best practices. Right?

What are ways that we can really help support individuals. We do that by way of webinars regional conventions, we have a national conference, training and just a whole host of activities to support and build the field of complex care.

EE:
Thank you so much, Victor, you know, just going to add a little bit. Last month we had Andy McMahoun joining us speaking about respite care and when I asked him about, you know, who needs these efforts.

I'm gonna paraphrase and he said that sometimes it just takes a champion that comes out of nowhere to lead efforts and communities and I gotta say, Camden coalition has taken that baton and run with it. And so, we, I really appreciate the efforts on behalf of complex issues that the coalition is to lead these dialogues in sometimes in communities where they haven't happened before so of course we'll dive a lot more into that.

Yeah, and Cesar. Inland health plan is near and dear to my heart I come from the area my family lives in the area, you are unique in the country and that you have inner urban hardcore areas and then you have rural communities and then you have desert. It's your breath and diversity is so large, perhaps a little insight into IHP.

Cesar Armendariz:
Thank you. And yeah Inland Empire health plan we are celebrating our 25th year of existence this year started in 1996. Actually the joint powers authority, San Bernardino and Riverside counties to come together to provide health care for some of the most needy.

And now 25, years later, we're serving over 1.35 plus million members across both counties. So, that equates to about one in every four in the entire Inland Empire region is an HP member. And we're also not for profit Medi Cal and Medicare health plan.

And yeah geography is quite big. If you think about it, if you're looking up from an area from the Ontario. To the west, going all the way to the borders of both Nevada and Arizona. So remember San Bernadino, actually, the largest geographic county in the entire US. So we can go there from really downtown San Bernardino, but when we do have inner city socio economic issues as most other cities do all the way to blight on the way to Arizona, or present in Barstow on the way to Las Vegas, and we go all the way down to those familiar with Coachella, we're out there in that area to help in the farmworkers in those different various communities to downcast Riverside.

So I'm happy to be here and a big fan of Camden as well so happy to be here with Victor,
thank you so so yes thank you both of you.

EE:
You know, we use the term complex care for these issues are complex and multifaceted solutions, even for maybe a simple issue what we think of simple, or one issue can require multiple individuals multiple organizations to get involved and frankly, most of the time as you guys will probably say the ideal solutions probably don't exist in your in your, your organizations in particular well known for kind of leading innovations in creating new Coalition's and partnerships if you were sort of wondering, maybe you could start us off here what's, what have been some of the keys for you. And IHP and getting very to unity resources to maybe buy into a new approach to to to solutions.

CA:
One of the things that I did early on was invite a lot of the key CTOs and accounting partners to the table. And especially as back as 2014 actually created the Inland Empire, the collaborative of county personnel, leading city based, nonprofits, the different really stakeholders, even faith based ending meet at our facility twice a year. And it's grown to invite over 4000 different organizations throughout the IE, that can participate now either virtually menu in person.

And the whole idea was that early on and again in 2014 we started realizing we can't talk it alone. And many times they come together and it's issues that we need to solve for them, so it's not about superficially Hey come here and how do you take care of our complex members. The issue came about how they come together and take care of each other for the community. And through that genuine, authentic relationships that are established with many of these organizations, we become really great friends, many of them know charities, or organizations we sit on many of their boards. So became this really just family member.

So when a complex cause presents and we need to bring in interdisciplinary care team, a community nonprofit. Another type of health organization somebody else in that space we can call on our friends and invite them in. So the key for us was just active engagement. Early on. And just opening up.

In fact, we just built the new building, dedicated so that we can have a greater larger space for our community partners to come in. Meet, and then use that space for their gathering and. So under your belt comes down basically to, you need to be a good partner up front, and bring them in have those conversations. Before the complex situations can come to the table. Being proactive

EE:
I love that. So, I'm gonna throw the same question your way but with a little twist. Sometimes the organizations we're trying to bring together have different, and maybe even competing perspectives and not to imply this but I always love the fact that the camping coalition work, really, if I am describing it correctly, Dr Brennan's work began with law enforcement and evolved into a healthcare coach and that's not typically how we think of bringing healthcare solutions to the forefront through law enforcement. So could you add perhaps your perspective or ancestors words, and particularly how sometimes we bring diverse. I don't want to use the word opposing. But folks that might have different perspectives to the table and common dialogue.

VM:
Yeah, man I think that's very important. We can highlight a good point. And I think, you know, in our roots has always been to create a big table. Right, and to create a diverse table with the understanding that you know we need as many different perspectives as possible in order to understand the problem right and so those perspectives. They actually represent data points. Right, so the more data points that we can have, as we're looking at a problem that allows us to come to a conclusion, or an outcome. That's a little more clear. Right.

So, you know, when we think about our big table and diversity, they may include different sectors, different organizations, including even individuals from the community persons with lived experience, and then you drill down to the care team level that diversity may look like a nurse, working with a social worker or working with a community health worker right and you just have that diversity, again, and then care planning. Again those perspectives, help and assist that patient or that member at the individual level. Right.

And so again, diversity of thought, right diversity of perspective, different data points, which helps to assist that person. And so I think that runs through right from the patient level to the system's level right creating that big table, and being willing and able to have difficult conversations. You know, the work is challenging. The work is complex for for many many reasons. But as CCR mentioned earlier, having those conversations up front, and being willing to engage that dialogue.

EE:
I love that concept of a big diverse table, and I think you would both agree that the patient, as long as they're at the center of that table that's what drives it. So, so this one. I'm going to throw it out there, against us and maybe you might lead us because you would have talked a little bit about this. Over the last few years. So, you know, we've got to bring people to the table, some of them, there might be an obvious ROI financial benefit to come into our dialogue we might improve their utilization of resources but other resources may not necessarily have an ROI of a financial incentive to come to the table. In fact, it may cost them dollars, and they may wonder why am I going to put money into something that may not produce increased financial results for my organization. Talk to me a little bit about how you you approach that how you might bring some innovative ways to incentivize folks to begin dialogue, and maybe look at a long term approach for them.

CA:
Sure. I'd do it  like a two prong approach.

One there's the more holistic altruistic viewpoint. the dialogue of the fact that hey there's a greater need out there. And if we join together, like we can try to help more the societal needs more help our patients that you know the greater societal return, we can, we have those conversations and try to get to the heart of just can we agree together.

And then there's the more actual just technical quid pro quo, that seals the deal, right, but we have to have context hey we should do the good work together. But here's how it can be beneficial to both.

And so obviously we find that win win for each other. And for some of these organizations, you know there are some of them provide amazing work but they may be nonprofits themselves right and so they're struggling just to do what they need to do.

So what we do is again we're proactive. So, we're actually invested in throughout the year when they have activities or fundraisers you can think we're there. So we're maybe they may not be able to get a full return on helping us that we'll be able to pay it back in a different way via a sponsorship of some sort, via our, our volunteers going out and helping their causes. And so for us promoting through our network the work they do doing other referrals, partnering up on grants together so that we become the gorilla weight that basically advocates for them to get more money elsewhere to do the work.

So we found ways that we can actually invest into them. And in some cases, we actually just do invest in them, we've actually found it more cost effective for us to go out and build capacity for some of our partners, so that they can turn around and do the good work and help our members, whether it be in the housing space the food space, other spaces. And what ends up it goes comes full circle once they realize that we're in it, we put our money where our mouth is then goes broader conversation about yeah there's been more and bring work together, actually come to fruition. So, that's the beauty of it. Yeah, we do need to invest upfront, and we can just be all teachers need to give. But it's also nice to bring it back to the greater needs of the community.

EE:
Victor with you add anything to that.

VM:
Yeah, and I would just you know add that, you know, starting to have a more expansive view of what the ROI may include right and so thinking about what is the return on value. Right. And so, how do you quantify or how did you measure community relationships, right how do you quantify or measure workforce creation development or enhancement and that way. How do you quantify or measure patient, remember capacity, right and engagement. And so, how do you quantify or measure authentic healing relationships, right, connections that people are able to make with health care providers and persons within our community, right family next door neighbors. And so how do we start to think about measurements that actually get it. Some of the positive outcomes that many of our programs are providing that aren't always highlighted in a consistent way.

EE:
Thank you. I love that the truth I can elaborate on that a little bit. Is there a common approach and this question comes to you all sorts as a common approach, such as. Do you generally start with, we have this common patient. And we're seeing X Y or Z; you may be seeing a, b and c.

That's dialogue or maybe a Community Health Needs Assessment analysis and we recognize we all have this common issue let's dialogue about this issue. Is there a commonality on how the dialogue begins.

VM:
Yeah, and I think is both. Right. I think oftentimes starting at the patient level to person level that allows you to stay rooted in just real issues that are happening in real challenges that individuals are experiencing it focusing right. How do we improve the quality of care for this person, what are your resources, what are our resources, how do we reconcile how do we negotiate, how do we then prioritize who's responsible for what and move forward. Right.

And so once having a couple of those examples in place, and then it's you know how do we quantify trends right how do we look at commonalities between the members that we've worked with together resources in a community, things that might be missing gaps and other things and so I think oftentimes, starting at the patient level is helpful folks are able to sometimes put aside their organizational pets, right, for the sake of the participant or the member. So I think that that's always a great place just to start just to get into the work.

EE:
Cesar, anything you would add to that.

CA:
Yeah, I would agree with the macro and the macro. I'll give some examples to like for us to help plan that we work directly with providers and hospitals. We also work directly with a county or the behavioral health team, and other CEOs. And once we identified the needs of the patient, we can bring them all together.

And because in the end, they're going to be hitting all the different stakeholders together, and impacting one another. so it is we all have a stake to help this patient and if we don't do something up rapidly but we're going to be addressing this and we're all gonna incur additional costs.

So absolutely, and then you brought up the community health needs, and that's another way we look at as we have this conversation. So we work with a 32 hospitals across our region. And we break it up in six different regions. And so we look at the health plant population needs assessment. And then we overlap it, the hospitals. Community Health Needs assess for that local region. And then we're also really blessed that in our backyard is ESRI in Redlands and the Inland Empire, so we use GIS heat mapping, as well.

And all those informatics data to go by and really pinpoint at really at a community level where all the different hotspots. And then we share that with civic leaders we share that with the hospital share that with others and realize, these are the geographies, we have to have a concentration and change the social fabric, if we're going to do any long term really gain
in the community health.

EE:
For the listeners that may not be familiar give us maybe a 30 second definition of heat mapping.

CA:
Sure. So, you can think of a map. And then you can lay it over, whereas greenspace rather than liquor stores, whereas other grocery stores where our bus stops and so forth, and you can layer, layer, and for our case, we can identify where members live. And then we can cluster it. And so then you now have this really robust real time map, that is organic in mind that you can pinpoint where all the different needs are from acute health needs assessment, or even ours.

EE:
Thank you I really appreciate that. So, Victor back to you. You know, I think one of the things that Camden and an empire, do so well is, you know, a complex patient's going to have a variety of needs. We got to address, immediate needs but we got to be thinking about long term needs as well. And those are gonna involve different resources. How do you engage different resources in dialogue that you know you have immediate needs you probably gotta get those resources on board, early on but then we start broad and bring everyone to the table right away or do we start with the early win and slowly build the polish.

VM:
Yeah, and I think, you know, it varies and as he was asking that question. The thought of a person that I have worked with some time ago, in my early years at the coalition. He was a gentleman who had been to our local emergency departments over 100 times in a period of four to five months.

We have three major health systems or at the time we had three major health systems in our region. So just person but you know frequent all of our systems, you know, sometimes two to three in the same day, you know, all three throughout the week at various times of the day. So eventually, we came to that, you know, we need to all get on the same page in terms of our regional approach our health systems even aware of the fact that this person is you know going to other health systems and getting similar services, the same treatment medications, sometimes double, things of that nature.

So we had a conversation right What are social workers at different health systems nurses, even pulled in the managed care organization. We asked permission of our participants, do you mind. Do you want to be a part of this conversation?

This is something that, you know, we think could help, just to make sure that we're all on the same page. So what came to bear in our conversation was that one health system.

And this was an individual who was experiencing homelessness, lived on a porch of an abandoned building limited social support recently divorced, and would just go to the hospital, basically because of isolation and food. One of our health systems had no record, no social work record on this particular participant, and it was noted that the times that he was going to the hospital. They didn't have social workers on the floor. Right. And so that's a systemic issue. Right.

It was also noted that one of the health systems, made repeated efforts to reach out to the managed care organization who was now at the table, but those messages weren't getting through to the right department within that managed care organization so that they could support, and that service that whatever resource that was needed. And so we were able to handle that conversation. And so, I say that to say, you know, yes there are issues that people are experiencing at the micro level. But, and a lot of these challenges happen at the system level because of our lack of coordination. Right.

And so how do we respond, together with a more concerted strategic effort to build ecosystems of care around individuals, so that we can better support individuals who fall through the cracks systematically.

EE:
Well I love that, you know that, your term of "equal systems of care victory."
 
This will be a topic for a future podcast, but soon we will do one on some of the electronic HIE programs that are out and how valuable they've been in helping us address social determinants of health collected medicals the crisp statewide programs. And it's so valuable to take information and share it across multiple partners in a common language.

VM:
Yeah. And if I may, so we actually run our regional health information exchange in Camden. And so what we recognized very early on was that you know our health care partners are really focused on it right they used it in terms of their work. But there was a disconnect between social service providers. Right. And so, lately. As of the last year or two, We really really really just thought to engage mental health providers, social service providers sheltered services providers, individuals who normally wouldn't have access that type of data. Right, so that they can make more informed decisions about the care that they're providing and really, you know, again, build that ecosystem right is broader than just healthcare, because so many different organizations and entities that touch on the people that we work with. And so how do we include them in the picture.

EE:
You know I love that sharing common information. And then I want to parlay this next question on top of that, how do we then share our successes so we're going to be in engaging multiple different organizations that tell their stories differently use different electronic records or dashboards to be create a unique dashboard for each community we're serving how do we share a common set of metrics so maybe you can launch with some of the stuff that IGP has been been involved with how do we share metrics and success across organizations that may be measuring things differently.

CA:
Yeah, that's a really good point too because I think one of the critical aspects that we do all this great work. But if we can't share the stories and others can't learn from it and we've only limited, that scope. And we're under the notion to that, it's fair game, but if there's multiple players at the table everybody should have equal say in that success we can't be egotistical.

And then, and for, whether it be just actually however they choose to publicize it. And then, and and whether it be their websites social media literacy, press release was so forth. It's all good. As long as it also had that spirit of cooperation that we do mention each other, then there's also actually coming together in writing white papers case studies that we can learn from that hopefully get actually published, and then actually writing those synopsizes with nice letters with all the signatories sharing with our elected officials, those that are the policy decision makers, so they understand the successes of the local level.

And then even convening it sometimes folks together convening folks to an a platform. So that we live the conference and sharing the good work that needs to be done. So, we were all for that and believe in all that. And it was still evolving for us. We're in a tight space as well with the hospitals and so forth and distracted with the letter to the governor's office and kind of advocating for greater passivity and all that. And so we're looking for partners, and I think we're better just to touch the surface in that area of what we want to do and how we're going to share stories. But love to get with victory status. Yeah.

VM:
And so, As you were speaking, you know, was thinking about how oftentimes, dollars. Funding impacts to narrative impacts the stories that our organizations, tell. And sometimes you know dollars funding support also plays a role in fragmented services. And so, who's looking at the community's narrative, right from a population health perspective and so, you know, I'm going to take off my institutional head. You know, the health system, they're going to go out there and institutional head to CBO everyone take off your institutional head, and let's look at this from the community lens in front of community lens. Now, let's think about how do we set unified metrics, and how do we set unified goals. Right. And so those goals may be different from my organizational goals. They may be different from our organization, those vision. But how do we play a role in the communities, or the population as a whole, their ability to manage these particular challenges.

EE:
I love that Victor and I think this question I find it a little bit tough but I think it probably is so importantly on what you just mentioned, you know, these organizations we're collaborating with are coming from different perspectives. If something doesn't go as planned. There's going to be finger pointing this starts I mean we all know it you know, people want to step back right away. How do we go actively preemptively kind of avoid finger pointing and keep the dialogue movie even when we stumble?

VM:
So a part of it is not, you know, if is when. So we know that that's going to be a part of a right this process. Right. And so, talking about that very transparently upfront right when things go awry. When you know measures are met or outcomes are delivered. What is our plan of action, not our plan of action as an organization, but our plan of action as a collective. And so how will we have a unified message right around, whatever deliverable that we're trying to achieve. And so, again, we'd sometimes talk about, you know, collaboration right partnership and all these things are great, and we firmly believe in them. But if you're doing it right. You probably have some sleepless nights. You probably leave some meetings with headaches. And sometimes you might even avoid a few phone calls. If you're doing it right, those things come with the work. Right. But again, is how do I engage those things when it does happen, because it's going to happen.

EE:
Cesar any things you'd add to that.

CA:
Yeah, I agree. You can't escape it. So we know it's gonna happen. And so we definitely have to get ahead of it. And I think when we come together, we need to everybody throw on the table, what does success look like for them.

Well, as long as we know what everybody's thinking is, whenever we can actually be proactive in that, in that sense, and, and we can always take points to prepare to not face that earlier. But here's another thing that I think binds us and this might relate to a lot of other communities nations you're listening, like for example us, we're in the Inland Empire, and we are next door neighbors to LA County. When it comes to competing for a lot of funding and support. I think it's tough for the lnm parents and Riverside County to compete against La La gets the lion's share of a lot of the funding the lion's share of the eyes the support and so forth. And so, it's even more important more reason for these groups Coalition's to work together and iron out differences. Because you have to stick together, because if we're divided and conquered. Then and fragmented, then less funding circles into the area to help you need to be consistent show stronger support. So collective impact, we're going to be able to compete against these larger, more urban cities.

EE:
I love that. thank you for bringing that Cesar.

VM:
I was just gonna say I think that that's a great question. You know, what brings us to the table. And another question is, what will cause my organization to walk away from this table. Right. You know what is that breaking point. For our organization, and having that be a part of the discussion as well. So that again is a transparent. You know conversation has been had amongst providers and folks know where organizations stand on that spectrum.

EE:
Absolutely! Not being caught off guard.

So, throwing that out up front so everyone can understand that better that is so important and something I think we don't do enough of. And frankly, I'm going to transition but but into something else we don't do enough of. I think we don't bring the voice of the patient to the conversation enough, we bring all these community Coalition's together.

I was on a, a presentation yesterday that Victor your organization hosted the Camden coalition hosted, and it was the first time in a year since COVID has arrived that I actually heard the voice of the patient on a national conference your brought a patient in and got her perspective on on tele virtual communications, and it was wonderful. Speak to me a little bit I know we're getting a little short in time but this question I think is so Paramount, because I think none of us do this well how do we bring the patient's voice into that community dialogue. Victor maybe you'd like to start us out since you did that already successfully.

VM:
Yeah, so it's a work in progress. You know, I think oftentimes when folks talk about engaging a community. They said they ended a process right when we're looking for that that stamp of approval to say you know yes this works or either, right, can we implement. And what we learned is that there's just not effective. In terms of engaging people right in terms of engaging communities and so for us. You know, it's always been important to engage a community to engage individuals who have lived experience and making them a part of the narrative, and not just a part of the conversation, but what is their role in shaping policy. Right What is their role in shaping systems. Right. And so we have a body of work at the coalition amplify right and it's our voices Bureau.

We work with individuals that have lived experience across the country, and we support them and work with them to serve on boards to speak at, you know, various engagements, to work on projects to work on state initiatives. But again, all of this with the vision of how do we include a diversity of voices, people who are impacted the most, how do we make sure that they're involved, very very early on at the outset of these projects and decisions that are being made.

EE:
So having them literally sitting on your various groups that are that are created. Yeah.
And this work is not easy again and you're doing it right, it takes, you know, a lot of support, a lot of energy and a lot of effort, but that's what we need in order to wrestle with some of these more complex issues that all of our communities, unfortunately are facing.
I've got one more question to ask for each of you because I know we're going a little overboard on time already. Do you find a need on a regular basis, to make sure that all of your organizations that are working on a particular issue are telling a common story? How much time do you put into our app we've done this, we've been successful we haven't been successful. How do we dialogue as a unit out to our community out to our patients out to whomever censor any thoughts on, on how we tell our community story.

CA:
So from the IHP perspective. Fortunately we were pretty tight knit we're, since we're out, not la in, we have to really represent such a large body we're really a family unit that and so we we don't have diverse voices that we have a lot of diverse thoughts and partners and so forth but we unite behind our mission, which is to to uplift the heal the human spirit. And it's just got to make a quick plug.

We were ranked number one top employer, and all the Inland Empire and number two in our area and help. And part of that is because there's this trust in the leadership that the voice that they're saying rep reflects the diverse thoughts and and needs the cares of us, so that we can go out and so when our CEOs or spokesperson goes out and says that we're 100% behind him. And then we're also respectful and listen to our other community partners and ensure that we're supporting their voice. And so, but for us internally, it's just been this family unity that we get behind a lot of work behind the scenes. When a message goes out, we're 100% behind it.

EE:
Thank you. Thank you, sir. Victor. You know, Camden's reach, as you mentioned, this is National, you're telling stories in Camden, they're on the East Coast but you're also involved with organizations, telling their own stories. Can you speak a little bit to that last question, how much effort, do you put into talking upfront about how we're going to dialogue or does each. We just support each organization in their own dialogue.

VM:
Yeah, I think that's a part of the work. Right. And so what we realized in our work is that, you know, while there are some similarities, every community is different, right, in some respects. And so, as we think about right that ecosystem that we referenced earlier. What is the voice of it. Right. How are we going to amplify that voice within this work. So whether that work happens in Camden, or that work happens on the other side of the country, in Clearwater, California, right. How are we going to amplify the voice of individuals who, again, aren't getting their needs met. But I do just want to say is that, you know, when we think about, we've thought about our organization we've oftentimes seen ourselves as an extension of the community. Right. And so, just to give you a concrete example. You know many organizations are now thinking about right COVID response efforts. And you know, vaccine hesitancy is real, in many communities right access issues real in many communities. And so from our perspective, you know, before we could go out into the community and talk about this, we had to start home. So we had to engage our staff in thoughtful conversations dialogue, where they can meet with health care providers within our organizations to have sessions, right to talk about perhaps challenges, experiences, and things that were top of mind for them, so that when they do go into community right they can serve as credible voices credible messengers. And so, unfortunately, oftentimes, organizations we don't spend enough time to think about our own people, right and the influence that they have within their spheres because when they go out into the community. They represent something, their message is something, right, and so we want to make sure that that message is consistent with the mission and values of the organization.

EE:
We could keep this going for an hour easily, but I'd like to wrap up. As is our tradition, we'd like to close if any of you have anything to add or any resource you'd like us to be aware of around creating coalitions. 

CA:
Yeah. First of all, thank you for the invite. It's great to be here with Victor. My only final thought is that the future of healthcare will be even more integrated, making these coalitions even more important. 

For a potential resource, the inland empire coordinated care initiative has an advisory community where you can get an idea of how we do this. Our members and community are a part of it too. It's a unique mixture people can see. That's inlandempirecce.org.

VM:
I think that there's a lot of examples of great work happening across the country.

One resource I'd recommend is the "BluePrint for complex care". It's a strategic plan for supporting folks with various needs in our communities and outlines how you systematically approach these challenges and work through them.

We also just released core competencies for frontline staff with the skills, knowledge, and expertise. This document outlines the competencies all frontline staff should have, regardless of their profession. More information can be found at our website at camdenhealth.org. 

People are looking for resources. So that's what we try to provide.

EE:
Victor, I have to give a shout out for the "Core Competencies" piece of work. It is golden and we try to incorporate it in all of our hiring, training, and operations at CBCS.

Cesar, Victor, thank you both as individuals and as organizations for your work. For our listeners, we look forward to talking with you next month.