We’ve all been enticed by the seductive myth that technology alone can effortlessly resolve the deep-seated issues at the intersection of healthcare and social care. This belief held promise for an efficient future where barriers to access and inequities were things of the past. However, the hard truth is that such promises were a mirage. If we examine social care technology initiatives across the country, it becomes clear that many have struggled to gain traction, undermined by challenges such as low adoption rates, misalignment with community needs, and a lack of transparency combining to erode community trust. Despite a decade of efforts to implement community resource referral technologies, the core issues in social care persist. 

In an era where state and federal initiatives, such as CalAIM and the CMS Accountable Health Communities Model, are pushing for the creation of digitally integrated care networks, the need for a smarter approach has never been more pressing. These efforts are reshaping our systems right now, and yet technical advancements like closed-loop referral systems, data standardization, and interoperability cannot, on their own, inspire the trust and widespread adoption of social care technology needed to improve the health and well-being of communities.

How, then, can we build social care infrastructure—centered on trust—that can drive positive outcomes at scale?

Empower Participation with Supportive Incentives

The first problem we have to acknowledge is that community-based organizations (CBOs), staffed by frontline providers with community knowledge, are perpetually underfunded, understaffed, and marginalized within existing power structures. They are already struggling to meet public demand for community resources, so any influx of referrals or increase in administrative burden created by newly implemented digital care networks calls for a corresponding increase in funding. 

In addition to the new Medi-Cal billing frameworks offered by CalAIM, we propose a range of supportive incentives designed to expand the capacity of CBOs and acknowledge their critical role in the success of our social care ecosystem. Here are a few approaches we think could be useful during the CalAIM implementation and beyond:

• Financial Incentives: Give CBOs equitable remuneration for their engagement and service delivery within the network. This approach directly addresses the funding shortfall, enabling organizations to improve capacity to meet public demand.
  
  
• Success-Sharing Models: Introduce success-sharing initiatives that reward collective achievements and improvements in service quality. This method drives toward collaboration and shared accountability among stakeholders and incentivizes investment in regional initiatives to address Social Determinants of Health (SDoH) and social needs.
  
  
• Data-Driven Recognition: Publicly recognize CBOs that demonstrate exceptional performance based on relevant and publicly available impact data. This would promote the visibility of effective practices and performance metrics, enabling successful strategies to be implemented more widely.
  
  

Ultimately, meaningful incentives and transparent use of data will foster the trust and reach social care technology requires to deliver on what it promises to communities.

Balance Coordination with Decentralization

In communities across the country, it’s common to find multiple social care systems at play. While this decentralization empowers grassroots innovation and local responsiveness, it often contributes to our current fragmented landscape and, without sufficient coordination, can perpetuate inefficiencies and systemic inequities. 

We would like to see a balanced approach, one that combines the benefits and innovation that arise from decentralization with the information exchange, standardization, and coordination centralized digital infrastructure can offer. 

For California, we recommend the following within the framework of CalAIM:

• Integrate Community-Guided Governance: Implement a shared-governance model for the oversight and continual development of regional care networks, one that enables diverse, community-based stakeholders—from CBOs to local providers, local governments, and residents—to have a seat at the table with policymakers and contribute to the analysis, discussion, and promotion of best practices in care coordination and data exchange across the State.
  
  By facilitating regular feedback loops, this model would ensure that the dynamism and learning inherent in decentralized systems are built into the ongoing refinement of digital care infrastructure and help such systems adapt and evolve practices to meet changing community needs.
  
  

Our hope is that CalAIM and similar initiatives can avoid the pitfalls of the top-down, one-size-fits-all approaches that lead to systemic problems in social systems, as seen in education reform efforts like No Child Left Behind and Common Core. By integrating community governance into California’s statewide vision for care coordination and data exchange, we can ensure that strategies are rooted in community needs.

Relationships as Infrastructure

While technology can go a long way toward facilitating service coordination and information sharing, relationship-building is the glue that binds the infrastructure together. As such, we recommend that reforms not only facilitate but also enhance relationships among stakeholders who are connected through digital care networks:

• Backbone Organizations as Advocates: Beyond their role in technical facilitation, backbone organizations are uniquely positioned to act as trusted, neutral third-party advocates for CBOs. Through advocacy, backbone organizations can amplify the voices of CBOs, advocate for their needs, and ensure their equitable participation in regional and statewide systems. In this role, they can help close the policy gaps between what the CBOs need and what they receive from the state and county entities. This is a critical step toward maximizing the effectiveness of backbone organizations and preventing them from acting solely as bureaucratic entities or replicating existing inequities. Notably, many Closed-Loop Referral (CLR) systems implemented in California and across the U.S. lack these backbone organizations, contributing to struggles in system utilization. Our recommendation is that communities invest in developing this crucial layer.
  
  
• Invest in Collaborative Practices: Investing in digital care infrastructure should go beyond allocating resources to recognizing the return on investment that collaborative relationships and partnerships deliver to social care. Fostering these relationships—through joint training programs, shared platforms, and community events designed to nurture partnership among healthcare professionals, social services agencies, and CBOs—can result in innovative initiatives, improvements in service delivery, and, ultimately, better outcomes for the communities being served.
  
  Additionally, adopting equity-centered frameworks like Collective Impact to co-develop community impact metrics for referral systems can help ensure that stakeholders across the ecosystem are aligned with mutual accountability and shared goals. 

A Holistic Vision for Digital Care

To transcend the challenges in the social services landscape, we need a shared vision—one that integrates a deep understanding of stakeholder needs with an unwavering commitment to trust and collaboration. Our aspiration for California, and for the entire nation, is that initiatives like CalAIM mark a transformative shift toward a future where digital infrastructure and the people-centered ethos of social care converge to create the sustainable change every community deserves.

Want to learn more about our 2023 projects and initiatives? Check out our recent Annual Report: Community Empowerment in Action.