Quick Finds: Value-Based Health Care Transformation

Population Health Management Task Force National Learning Series 2024 (2024). Resource Type: Archived Webinar. Description: This national learning series, sponsored by HRSA, takes a deeper dive into issues related to HIV, Diabetes, and Chronic comorbid disease management, which all impact population health management. More Details...

How to Use Population Health Tools to Stratify Your Population for Care Management (2024). Resource Type: Archived Webinar. Description: This webinar demonstrates how to use population health electronic tools to identify patients with chronic illnesses with an obesity (or elevated BMI) comorbidity. Having this information allows health centers to identify the patients who would benefit from care management, additional resources, and care coordination services. More Details...

Improving Hypertension Management: Applying Standing Orders and the Role of Medical Assistants (2024). Resource Type: Archived Webinar. Description: Presented by Mary Blankson, Chief Nursing Officer for Community Health Center, Inc. (CHCI), this session will cover how to implement standing orders using CHCI's hypertension guidelines and other national best practices. It will emphasize the key role of Medical Assistants (MAs) and demonstrate how standing orders support broader healthcare initiatives. Participants will gain knowledge on how to apply standing orders for hypertension management in their own health centers to improve patient care and streamline clinical processes. More Details...

HIV Prevention and Care for People Assigned Female at Birth (2024). Resource Type: Archived Webinar. Description: Presented by Dr. Whitney Irie and Dr. Kevin Ard in collaboration with the National LGBTQIA+ Health Education Center, this webinar will train health centers on best and promising practices for prevention and treatment of HIV among cisgender women, non-binary people assigned female at birth, and transgender men. More Details...

Caring for LGBTQIA+ Youth at Health Centers (2024). Resource Type: Archived Webinar. Description: Presented by the National LGBTQIA+ Health Education Center, this webinar will focus on both disparities and resilience among LGBTQIA+ youth, including practical strategies for reaching and engaging LGBTQIA+ youth into primary care and behavioral health care. In addition to learning of health risks faced by LGBTQIA+ youth, webinar participants will become more familiar with LGBTQIA+ youth culture, and will learn of ways to forge trusting relationships and create welcoming environments. More Details...

Addressing Mental Health Experiences Among Subpopulations of Migrant Seasonal Agricultural Workers (2024). Resource Type: Publication. Description: This two-part article series highlights the vital role of Community Health Workers (CHWs) in addressing mental health challenges faced by Migrant Seasonal Agricultural Workers (MSAWs). CHWs leverage their deep understanding of community needs and cultural sensitivities to facilitate open discussions about mental health, combat stigma, and connect individuals to essential resources. By encouraging open dialogue and mutual support, communities can effectively tackle mental health disparities. More Details...

Disaster Equity: Preparedness, Response, and Recovery for LGBTQIA+ Patients of Health Centers (2024). Resource Type: Publication. Description: Climate change and natural disasters pose substantial threats to communities, the effects of which are exacerbated by inequalities in vulnerable populations—particularly those with intersectional marginalized identities (e.g., LGBTQIA+ people who are Black, Indigenous, and/or have a disability) and are disproportionately affected by chronic disease. It is vital that health centers pay special attention to the marginalized communities who have been historically forgotten in emergency preparedness and response plans. Social determinants of health such as stigma, discrimination, violence, neighborhood characteristics, transportation, and a lack of recognition of families and relationships in institutional policies dramatically impact the effects of natural disasters on LGBTQIA+ people. This publication will summarize the issues at hand and provide strategies for health centers to promote disaster management equity for LGBTQIA+ patients. More Details...

FQHC Financial Readiness and Projection Tool (2024). Resource Type: Toolkit. Description: This tool is provided to assist community health centers in evaluating their financial readiness for value-based payment models as well as estimates of projected revenues, costs and returns on investment for various alternative payment arrangements. More Details...

Value-Based Payment (2024). Resource Type: Online Self-Paced Learning Modules. Description: This 4-Part Webinar Series is designed to meet health centers and health center partners along the Value-Based Payment (VBP) readiness continuum – from Planning, to Implementing, then Optimizing.  More Details...

Supporting Survivors of Violence and Abuse in Oral Health Care Settings: A Patient Brochure and Guide for Staff (2024). Resource Type: Publication. Description: Oral health care staff and providers have an opportunity to work on both systems and practice change to help community members access care and have comfortable visits, including for survivors of violence and abuse. Staff can routinely share information with their patients on violence and abuse, and connect patients to supportive community programs, national hotlines, and onsite advocacy. Health Partners on IPV + Exploitation, in collaboration with the National Network for Oral Health Access (NNOHA), developed two trauma-informed resources: An oral health team member fact sheet on providing inclusive and sensitive care to patients. A brochure for patients, focusing on those who have experienced or are experiencing violence to help them have better visits and access to safety support. More Details...

Data Visualization for Value-based care: HITEQ Resource (2024). Resource Type: Publication. Description: This resource details how data visualization can be employed to support value-based care and includes suggestions on how to depict measures and trends using data dashboards. More Details...

CHWs: The Key Players in Heat Stress Management Strategies Among MSAWs (2024). Resource Type: Publication. Description: As global temperatures rise, Migrant Seasonal Agricultural Workers (MSAWs) are increasingly at risk for heat-stress health issues due to their work conditions. Proactively involving Community Health Workers (CHWs), Federally Qualified Health Centers (FQHCs), and local communities can raise awareness and provide essential support to mitigate these risks. By collaborating on education, emergency preparedness, and advocacy, stakeholders can take a strategic approach to improve conditions and health outcomes for MSAWs facing the impacts of climate change. More Details...

CHWs Supporting MSAWs' Health Across Life's Seasons (2024). Resource Type: Publication. Description: Community Health Workers (CHWs) are essential frontline public health workers with deep cultural understanding and adaptable skills. They play a crucial role in supporting Migrant Seasonal Agricultural Workers (MSAWs), who face unique challenges due to their transient work and diverse backgrounds. CHWs provide vital services such as healthcare access, language interpretation, legal guidance, and culturally appropriate support, ensuring MSAWs receive comprehensive care across different locations and life stages. This integrated approach supports positive health outcomes and addresses systemic barriers through community-driven initiatives. More Details...

Social and Structural Impacts on Diabetes and Comorbidities Management for AA and NH/PI Populations Learning Series: Module 5: Culturally-Responsive Diabetes Care: Integrating Language and Family (2024). Resource Type: Micro-Learning. Description: The Association of Asian Pacific Community Health organizations (AAPCHO) chronic disease management programs, expertise, and national network in the AA and NH/PI community health center space, will feature research, community intervention strategies, and historical context for diabetes and other co-morbidities among AAs and NH/PIs. This self-paced learning series will feature modules that outline various social, political, and structural drivers of health for diabetes and comorbidities management. Modules will include case studies which promote resources, strategies, and interventions to support health center performance improvement and transformation efforts. This is module 5 and was recorded on June 18, 2024. More Details...

Social and Structural Impacts on Diabetes and Comorbidities Management for AA and NH/PI Populations Learning Series: Module 4: Bridging Community and Clinic to Promote Diabetes Equity in South Asian Communities (2024). Resource Type: Micro-Learning. Description: The Association of Asian Pacific Community Health organizations (AAPCHO) chronic disease management programs, expertise, and national network in the AA and NH/PI community health center space, will feature research, community intervention strategies, and historical context for diabetes and other co-morbidities among AAs and NH/PIs. This self-paced learning series will feature modules that outline various social, political, and structural drivers of health for diabetes and comorbidities management. Modules will include case studies which promote resources, strategies, and interventions to support health center performance improvement and transformation efforts. This is module 4 and was recorded on June 5, 2024. More Details...

The Health Of Asian Americans, Native Hawaiians, and Pacific Islanders Served at Health Centers: An Analysis of the 2022 Uniform Data System Report (2024). Resource Type: Publication. Description: This report was developed by Association of Asian Pacific Community Health Organizations using the 2022 Uniform Data System data from health centers to examine the current state of health center performance and provides recommendations for how health centers can improve. More Details...

"Integrated Care for AA and NH/PI Youth Patients" Webinar (2024). Resource Type: Archived Webinar. Description: On Thursday, May 2, AAPCHO convened a webinar detailing the essential role of Community Health Workers (CHWs) in providing youth services. Speakers shared about building trust and delivering culturally-responsive and identity-affirming care strategies through cultural farming practices, traditional arts, and peer outreach to ensure that youth have access to care. Listen to the Recording: https://bit.ly/3QyAd1T Webinar Slides: https://bit.ly/youthwebinar2024 Transcript PDF: https://bit.ly/4bfF94o Transcript Plaintext: https://bit.ly/3y80RZo More Details...

Social and Structural Impacts on Diabetes and Comorbidities Management for AA and NH/PI Populations Learning Series: Module 3: Culturally Grounded Interventions to Improve Mental and Physical Health (2024). Resource Type: Micro-Learning. Description: The Association of Asian Pacific Community Health organizations (AAPCHO) chronic disease management programs, expertise, and national network in the AA and NH/PI community health center space, will feature research, community intervention strategies, and historical context for diabetes and other co-morbidities among AAs and NH/PIs. This self-paced learning series will feature modules that outline various social, political, and structural drivers of health for diabetes and comorbidities management. Modules will include case studies which promote resources, strategies, and interventions to support health center performance improvement and transformation efforts. This is module 3 and was recorded on April 29, 2024. More Details...

Clinical Workforce Development Fall 2023 Webinar Repository: English and Spanish Versions Available (2024). Resource Type: Publication. Description: The following publications present a summary of the NTTAP Fall 2023 activities and findings from an analysis of activities presenting relevant and pertinent information on clinical workforce development More Details...

Quality Improvement Strategies for LTBI Prevention and Care in A/AA and NH/PI-Serving Health Centers: National Clinical Quality Measurement - January 2024 (2024). Resource Type: Publication. Description: AAPCHO and the Tuberculosis Elimination Alliance held a learning collaborative, funded by the Centers for Disease Control & Prevention and the Health Resources & Services Administration, in April 2023. More Details...

Using PCMH to Improve Asthma Outcomes Webinar (2024). Resource Type: Archived Webinar. Description: The training reviews the practice of using a team approach to manage pediatric patients with asthma, engaging pediatric patients with care management, and exploring appropriate treatment options for asthma. More Details...

The Health of Asian Americans, Native Hawaiians, and Pacific Islanders Served at Health Centers: An Analysis of the 2021 Uniform Data System (2023). Resource Type: Publication. Description: This report examines current patient demographics and utilization of health services at health centers serving Asian Americans (AAs) and Native Hawaiians and Pacific Islanders (NH/PIs), and highlights the differences between these centers and the national average of all health centers in the United States. The analyses presented throughout this report are intended to improve understanding of AA and NH/PI patients served by health centers nationwide. More Details...

Asian American, Native Hawaiian, and Pacific Islander Survivors of Intimate Partner Violence and Human Trafficking: Health Center Preparedness Before, During, and After Emergencies (2023). Resource Type: Publication. Description: Developed in collaboration with Association of Asian Pacific Community Health Organizations (AAPCHO) and Health Partners on IPV and Exploitation, this educational brief focuses on equipping health centers (HCs) with the necessary tools and knowledge to support Asian Americans (AA) and Native Hawaiians/Pacific Islander (NH/PI) survivors of Intimate Partner Violence (IPV) and Human Trafficking (HT) during natural disasters and public health emergencies (emergencies). Structural barriers, language access, and lack of culturally responsive organizations often leave these survivors vulnerable. This educational brief provides insights and strategies for HCs to prepare and respond to support AA & NH/PI survivors. More Details...

Successful Steps for Holistic Integration of Mental and Behavioral Health in Primary Care Learning Collaborative: Part Four (2023). Resource Type: In-Person Training. Description: Session 4 or 4 delves into various quality improvement techniques. Participants learned how to apply the Plan-Do-Study-Act (PDSA) cycle effectively to bring about meaningful change within their healthcare settings. Practical tools and real-world examples guided participants in identifying areas for improvement and implementing evidence-based strategies. More Details...

Implementing Nurse Practitioner (NP) and NP/Physician Associate (PA) Postgraduate Training Programs: Program Development, Recruitment Strategies, and Accreditation (2023). Resource Type: Archived Webinar. Description: Join us and our peers at Open Door Community Health Centers as we dive into the key elements of successful primary care NP/PA residency programs. Discover program structure, recruitment strategies, bias reduction techniques, and the accreditation process. By the end of this webinar, you\'ll gain insights to implement and sustain effective NP/PA residency programs and enhance your clinical workforce development approach. More Details...

Successful Steps for Holistic Integration of Mental and Behavioral Health in Primary Care Learning Collaborative: Part Three (2023). Resource Type: Online Self-Paced Learning Modules. Description: Integrating behavioral health services into primary care requires effective financial planning and re-conceptualization of determining ROI. Session 3 of 4 focuses on enhanced billing practices tailored to integrated healthcare models and on determining the contribution of integrated BH to the finances of the primary care setting or the health system as a whole. More Details...

Enhancing Healthcare Access for Special Populations Through Telehealth and Home Visitation Services: Part Two (2023). Resource Type: In-Person Training. Description: Hosted by the National Nurse-led Care Consortium and the National Center for Health in Public Housing, this 2-part webinar series discussed promising practices in home visitation and telehealth as ways to support improved access to comprehensive primary care for communities with high levels of disability and isolation, lack of adequate transportation, and other social drivers of health that contribute to health inequities, particularly residents of public housing. More Details...

Successful Steps for Holistic Integration of Mental and Behavioral Health in Primary Care Learning Collaborative: Part Two (2023). Resource Type: Online Self-Paced Learning Modules. Description: Session two focused on enhancing understanding of integrated care models and aspects of gaining leadership support for successful implementation. Leadership endorsement is critical for the successful implementation of integrated care methods. Participants engaged in discussions centered around strategies to gain leadership buy-in. Case analyses and group exercises empowered attendees to identify key motivators for leaders and tailor their approach to effectively communicate the benefits of integrated care, thereby securing the necessary support. More Details...

Successful Steps for Holistic Integration of Mental and Behavioral Health in Primary Care Learning Collaborative: Part One (2023). Resource Type: In-Person Training. Description: Integrated healthcare is a unique way to detect and address the broad spectrum of psychological, biological, and social needs among primary care patients. In part one of this learning collaborative, participants explored different levels of engagement and examined this framework of collaboration and the different levels of integration; we also learned about key strategies for successfully implementing integrated health care in your healthcare setting. Participants were introduced to the framework for patient and family engagement and reviewed an organizational assessment to gauge where action can be taken. More Details...

Managed Care Data Checklist: Companion Document to Video Module: Payer Data: The Managed Care Data. Prepared by Starling Advisors for the HITEQ Center in July 2022. (2023). Resource Type: Toolkit. Description: How to Use This Checklist: This is a supplement to our Module 2: The Managed Care Data Set, which uses the HCP-LAN APM Framework as its basis. Review both before using this checklist. There are terms used throughout that may be new to you or may benefit from detailed explanations—please visit our Value Based Payment Glossary for basic definitions for a host of key terms. More Details...

PrEP Process Map Example: HITEQ Center, September 2023 (2023). Resource Type: Toolkit. Description: This resource is an example of a Pre-Exposure Prophylaxis (PrEP) Process Map. A process map is a picture of how a health center workflow moves from the start point to the end point. As you review the process map, make note of the design elements, such as use of colors, shapes, and icons, and the level of detail included in the map. You can download the process map in the Documents to Download section below. More Details...

Interoperability Readiness Scorecard: HITEQ Center, July 2023 (2023). Resource Type: Template. Description: Many health centers struggle to reap the benefits of technological advancement and investments in health information technology (health IT), while others embrace them and reap rewards. Interoperability is one such example; requiring health centers assess systems, relationships, and implementation. There are keys to successful interoperability implementation for which health centers must develop processes, stand up infrastructure (within the system, internally and externally, and organization), and then take action. Process refers to structured processes, policies, and procedures within the health center. Infrastructure refers to structural capacity and ability within the health center’s technology and staffing structure. Action refers to full implementation to the point of active and ongoing use and engagement. This scorecard encourages health centers to consider their processes, infrastructure, and action in a number of key areas. Each area key to interoperability are to be self-graded on a scale of 1 through 5, where 1 is poorly or not yet developed and 5 is well developed. Health centers can also use this to guide discussions and monitor progress over time. evaluate once steps have been completed. More Details...

Health IT Optimization for Effective PrEP Services: HITEQ Center, June 2023 (2023). Resource Type: Toolkit. Description: Health centers are increasingly interested in embedding oral Pre-Exposure Prophylaxis (PrEP) programs into primary care, which calls for the embedding of PrEP care processes into electronic health record (EHR) systems. Health centers have had success with automation in HIV testing, and are looking to apply automated algorithms, order sets, and templates to the development of PrEP programs. This resource outlines EHR and health information technology (IT) configurations and tools that support PrEP care processes and provides examples of successful implementation from health centers and primary care settings. More Details...

Using the RTAT to Assess Organizational Capacity (2023). Resource Type: Archived Webinar. Description: Improve educational training experiences at your health center by assessing your capacity and infrastructure to host health professions students. Join the upcoming hands-on interactive activity session to learn how to utilize the Readiness to Train Assessment Tool (RTAT). This tool was developed by HRSA-funded National Training and Technical Assistance Partners (NTTAP) at Community Health Center, Inc. (CHC) to understand organizational readiness to host health professions student training programs. More Details...

Social Determinants of Health Lessons Learned, Challenges, and Barriers: A Resource for Health Centers, Vol. 3 (2023). Resource Type: Publication. Description: The Association of Asian Pacific Community Health Organizations (AAPCHO), Health Outreach Partners (HOP), MHP Salud, and National Health Care for the Homeless Council (NHCHC), four HRSA-funded National Training and Technical Assistance Partner organizations, released a report on lessons learned, challenges, barriers, and impact stories shared from the (4) sessions of the “Acting on SDOH Screening Data to Address Barriers to Health” Learning Collaborative. This Learning Collaborative shared strategies to respond to SDOH data through enabling services staff, culturally and socially appropriate interventions, and internal and external organizational capacity. More Details...

Health Professions Student Training Webinar: Assessing Organizational Capacity (2023). Resource Type: Archived Webinar. Description: In order to provide a high-quality educational training experience at your health center, Community Health Center, Inc. (CHC) recommends assessing your capacity and infrastructure to effectively host health professions students. In the midst of competing priorities, best practices and tools will support this strategic workforce planning. Along with these best practices, panelists will discuss faculty's roles and responsibilities, as well as hear directly from CHC staff. Additionally, this webinar will introduce the Readiness to Train Assessment Tool (RTAT(TM)), a tool developed by HRSA-funded National Training and Technical Assistance Partners (NTTAP) at CHC to better understand organizational readiness to host health professions student training programs. More Details...

The Managed Care Data Set - Video: Developed with Starling Advisors in 2022 (2023). Resource Type: E-Learning. Description: This is the second in a three module value based care basics series from the HITEQ Center. This module was developed by Starling Advisors in 2022. More Details...

Health Centers Serving Veterans: Learn about the New PACT Health Benefits (2023). Resource Type: Archived Webinar . Description: This national audience webinar will provide health center administrators and provider teams with the most recent information regarding new health and service benefits passed by Congress in 2022, to be implemented by the US Dept. of Veterans Affairs. Specifically, the PACT webinar will explain the toxic exposure criterion and how health centers can screen and/or refer Military Veterans for the new benefits they've earned and deserve. More Details...

Implementation of Timely and Effective Transitional Care Management Processes (2023). Resource Type: Archived Webinar. Description: Join us to discuss best practices for integrating daily follow-ups for patients recently hospitalized for health emergencies. Effectively following up with patients is a critical responsibility for integrated care teams. More Details...

Specialty Care Access in Health Centers - What is the Potential of eConsults?: HITEQ Highlights Webinar (2023). Resource Type: Archived Webinar. Description: Access to care is the essential work of health centers, and one pain point is how to ensure specialty access for health center patients. This webinar will discuss innovation in specialty care access using technology and e-Consults. Electronic consultations (“e-consults”) are asynchronous, consultative, provider-to-provider communications within a shared electronic health record (EHR) or web-based platform. E-consults are intended to improve access to specialty expertise for patients and providers without the need for a face-to-face visit. More Details...

HITEQ Highlights: What You Need to Know About Managing Data in Value Based Care Contracts: HITEQ Highlights Webinar (2023). Resource Type: Archived Webinar. Description: This webinar will feature a panel of leaders in the health center world of value based care discussing how data can be managed and leveraged as a strategic asset. As value based care, alternative payment models, and managed care arrangements are becoming more common for health centers, health centers are called on to increase their knowledge and action in this area. Join us to hear from experts and pose any questions you have! More Details...

Implement Behavioral Health Training Programs to Address a Crucial National Shortage in Community Health Care Settings (2023). Resource Type: Archived Webinar. Description: Health centers are uniquely positioned to address the unprecedented need for behavioral health services but are challenged by the workforce shortage. Participants will gain the knowledge needed to begin conceptualization of a training pathway. Join us to discuss the considerations of sponsoring an in-house training program across all educational levels, including the benefits, program structure, design, curriculum, supervisors\' role, and required resources. Experts will provide participants with examples from practicum and postdoctoral level training programs to help them gain confidence in developing a behavioral health training pathway. More Details...

SDOH Screening & Referrals to Support Diabetes Control: Screening & Coding, Care Team Optimization, Referrals to the Community & Closing the Loop (2023). Resource Type: Archived Webinar. Description: In this three-part webinar series hosted by the National Nurse-led Care Consortium (NNCC), participants can expect to learn about the importance of SDOH screenings and whole-person wellness to improve diabetes management and outcomes. Presenters will share their knowledge of executing patient centered SDOH screening tools and referrals to support services while managing diabetes. This series will discuss implementing best practices for patient-centered approaches to care by utilizing SDOH screening and care team optimization and coordination. More Details...

HIV Prevention: Combating PrEP Implementation Challenges (2022). Resource Type: Archived Webinar. Description: Expert faculty present case-based scenarios illustrating common challenges to integrating HIV PrEP in primary care. As part of improving clinical workforce development, this session will delve into a variety of specific PrEP implementation challenges. Participants will leave with strategies to overcome these obstacles to establish or strengthen their PrEP program. More Details...

Advancing Team-Based Care: Enhancing the Role of the Medical Assistant and Nurse through Implementation of Care Management to Improve Chronic Conditions (2022). Resource Type: Archived Webinar. Description: Expert faculty outline the differences between case management, care coordination and complex care management to frame up a discussion on strategies to leverage effective models for both in-person and remote services. Expert faculty discuss the role of the medical assistant and the nurse in care management, as well as how standing orders and delegated orders support this work. This session will discuss how telehealth and remote patient monitoring enhancements can support complex care management for patients with chronic conditions. Participants leave this session with the knowledge and tools to begin or enhance implementation of chronic care management by enhancing the role of the medical assistant, nurse and the technology that supports the clinical care. More Details...

Partnership for the Future: Health Centers and Maternal Child Health Home Visiting Opportunities (2022). Resource Type: Publication. Description: The National Nurse-Led Care Consortium (NNCC) has developed a publication on Maternal, Infant, and Early Childhood Home Visiting (MIECHV) funded home visiting programs working in partnership with health centers. The publication outlines key steps and resources for integrating MIECHV programs and health centers and provides examples of successful collaborations. More Details...

Nurse-Led Health Care and Health Centers (2022). Resource Type: Publication. Description: The National Nurse-Led Care Consortium (NNCC) has developed a brief discussing opportunities for health centers to optimize recent increases in the nurse practitioner (NP) workforce across health centers. The brief provides a comprehensive overview of nurse-managed health centers and highlights the role of nurse-led care on improved provision of primary care. More Details...

How Compassion and Relationships Reduce Chronic Stress (2022). Resource Type: Podcast. Description: The National Nurse-Led Care Consortium (NNCC) invites you to listen to the first episode of their Fall podcast series. Join them in reflecting on how compassion and relationships can mitigate the negative health impacts of chronic stressors. More Details...

CalAIM: Major Components and Current Implementation Status (2022). Resource Type: Archived Webinar. Description: This webinar reviews the major components of the California Advancing and Innovating Medi-Cal (CalAIM) initiatives, including: Enhanced Care Management, Community Supports, Behavioral Health (Criteria to Access Specialty Mental Health and No Wrong Door), and the Population Health Management Strategy and Roadmap. Presenters will provide an overview of the initiatives, timeline, and strategic implications for health centers. This conversation is meant to be a high-level overview of the most impactful initiatives to health centers. More Details...

“Acting on Social Determinants of Health Screening Data to Address Barriers to Health” Webinar (2022). Resource Type: Archived Webinar. Description: AAPCHO, Health Outreach Partners (HOP), MHP Salud, and National Health Care for the Homeless Council (NHCHC) hosted a HRSA-sponsored webinar to explore strategies to screen special and vulnerable populations for social determinants of health (SDOH) and build effective practices to begin addressing SDOH through outreach and enabling services (ES). More Details...