As part of the Department of Health and Human Services’ (HHS’s) strategic approach to addressing social determinants of health (SDOH), we envision a future in which all individuals, regardless of their social circumstances, have access to aligned health and social care systems that achieve equitable outcomes through high-quality, affordable, person-centered care.
While identifying pathways to adequately fund social care is critical to achieving this vision, there is also a need for communities to develop sustainable partnerships among health care providers, the public health system, and community-based organizations (CBOs), and to develop the data and financing infrastructure needed to support these partnerships. Multistakeholder collaborations to address SDOH have flourished in recent years and have informed what is needed to develop a sustainable operating infrastructure between health care and CBOs to address health-related social needs. This infrastructure is increasingly provided by community care hubs (hubs)—community-focused entities supporting a network of CBOs providing services addressing health-related social needs—which centralize administrative functions and operational infrastructure. Hubs can benefit from multistakeholder community governance and planning, similar to what occurred in a number of the accountable health community model implementations. These efforts can help identify sources of financing that can support care coordination and service delivery, as well as ensure that multiple perspectives are heard and incorporated when making decisions about how best to screen, manage referrals, coordinate care, and deliver services. This includes ensuring referral technology platforms and workforce are used in a coordinated and equitable manner. Hubs, also referred to as backbone organizations, can include governmental as well as non-governmental organizations as funders, participants, and in some instances as conveners. They can also collaborate with local public health authorities to ensure that community population health strategies addressing SDOH are coordinated.
Here, we discuss the role and functions of hubs, provide examples of these organizations, and explore policy opportunities to maximize their role. (author introduction)
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