title: Bridging the Silos of Service Delivery for High-Need, High-Cost Individuals.
abstract: Health care reform efforts that emphasize value have increased awareness of the importance of nonmedical factors in achieving better care, better health, and lower costs in the care of high-need, high-cost individuals. Programs that care for socioeconomically disadvantaged, high-need, high-cost individuals have achieved promising results in part by bridging traditional service delivery silos. This study examined 5 innovative community-oriented programs that are successfully coordinating medical and nonmedical services to identify factors that stimulate and sustain community-level collaboration and coordinated care across silos of health care, public health, and social services delivery. The authors constructed a conceptual framework depicting community health systems that highlights 4 foundational factors that facilitate community-oriented collaboration: flexible financing, shared leadership, shared data, and a strong shared vision of commitment toward delivery of person-centered care.
authors.affiliation: 1 Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
authors.forename: Melissa
authors.initials: M
authors.lastname: Sherry
authors.affiliation: 1 Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wolff
authors.affiliation: 1 Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
authors.forename: Jeromie
authors.initials: J
authors.lastname: Ballreich
authors.affiliation: 2 University of Wisconsin-Madison School of Medicine and Public Health , Madison, Wisconsin.
authors.forename: Eva
authors.initials: E
authors.lastname: DuGoff
authors.affiliation: 1 Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
authors.forename: Karen
authors.initials: K
authors.lastname: Davis
authors.affiliation: 1 Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
authors.forename: Gerard
authors.initials: G
authors.lastname: Anderson
mesh_terms: D018672:Community Health Planning / Q000458:organization & administration*; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D017598:Efficiency, Organizational; D006301:Health Services Needs and Demand; D007857:Leadership; D019982:Organizational Case Studies; D015397:Program Evaluation; D014481:United States