ChristianaCare’s Office of Health Equity, in partnership with Unite Us, launched Unite Delaware on November 4, 2019. Unite Delaware is a coordinated care network of health and social care providers. Partners in the network are connected through a shared technology platform, Unite Us, which enables them to send and receive electronic referrals, address people’s social needs, and improve health across communities.
Once a participating community-based organization identifies a person’s social needs, they are able to instantly send a secure, electronic referral to the most appropriate network partner(s) for that specific service, via Unite Delaware. Partners involved in the person’s care will be able to see if that referral was accepted or not. Once accepted, they will learn whether the person received the services.
Unite Delaware is designed to resolve the issues that make referrals and connecting to services difficult. Perhaps most importantly, Unite Delaware takes the onus off the individual to track down needed services. Once a participating organization accepts a referral, it is their responsibility to connect with the individual. Participating organizations can search for the needed service and connect an individual to organizations that they may not have even known existed. Unite Delaware serves both individuals by connecting them to services and the participating organizations by empowering them to better serve their communities.
ChristianaCare decided to partner with Unite Us to address Social Determinants of Health because health is impacted by so much more than what happens in a doctor’s office. To complete ChristianaCare’s Community Health Needs Assessments in early 2019, the Office of Health Equity held town halls at which the communities ChristianaCare serves were asked to tell us about their barriers to good health. Much of those discussions focused on poverty, transportation, education, and other social needs that have an obvious impact on health, but that our clinicians cannot address without community resources. ChristianaCare has long prized its partnerships with community organizations and Unite Us provided us with the tool to strengthen those connections to comprehensively address the needs of Delawareans.
Unite Delaware also provides a unique data collection opportunity for participating organizations. Every organization on Unite Delaware has access to and ownership of their own data so they can see how many individuals they have served, who they are serving, and what needs were met and unmet. Network aggregate information, particularly what the most in demand services are and what services go unmet, will help the Office of Health Equity direct its community investment. For example, if referrals sent for individuals in the 19802 zip code are primarily for food assistance, the Office of Health Equity will seek out community partners in that area to determine how to address this need.
The desire to help address all our patients’ needs – even those needs outside of our area of expertise, is what links us to the libraries. Just as patients at a doctor’s appointment may express concern over childcare or utility payments, a patron of the library may also come to the library needing to use a computer and reveal that they need health insurance or recently lost a job. At libraries and in healthcare settings, we are confronted with the complex and fundamental needs of those we serve, and often, we do not know enough about the resources available or that need to offer them much in the way of support. Under the leadership of Dr. Annie Norman, the libraries have undergone a transition to help comprehensively address their patrons’ needs. You can now, for example, connect to a Department of Health and Social Services Social Worker through the library website.
This past December 2019, the libraries hosted Better Together: Serving Delawareans’ Basic Needs Networking Meeting. At this meeting, community and government organizations came together to talk about the needs of Delawareans, the services that are available, and the question of how Delawareans can be connected to the services they need, when we may not know the first thing about that need. Without knowing it, participants at this meeting were describing Unite Delaware as the solution for connecting Delawareans to services. Very soon after that meeting, representatives from the Office of Health Equity met with Dr. Norman and Alta Porterfield, Statewide Social Innovator for the Delaware Libraries, to describe Unite Delaware, and it was not much later that the Delaware Libraries joined Unite Delaware. We have been grateful for the support of the libraries and the encouragement they routinely give to other community organizations to join the network.
During the COVID-19 pandemic and what many of us are calling the “new normal” with working from home and community events and meetings postponed for the foreseeable future, Unite Delaware is uniquely suited to address the heightened health and social needs. The pandemic has demonstrated the importance of Unite Delaware as the referrals sent on the platform more than doubled between March and June in comparison to the referrals that were sent from launch in November to March. Given the growing need and obvious utility of Unite Delaware, the Office of Health Equity made the determination to expand Unite Delaware rapidly. When Unite Delaware launched, it only served New Castle County. Our intention was always to expand statewide, but the pandemic gave us the motivation we needed to pursue that expansion much sooner.
Since June, the Office of Health Equity in partnership with Unite Us have been working to recruit organizations in Kent and Sussex Counties. New Castle County organizations continue to be welcomed to the platform as well. There is no cost to joining the network and we are eager to continue to recruit organizations. As of this writing, there are over 50 participating organizations on the network, and this number is growing daily. If you are interested in learning more or joining, please visit our website: https://delaware.uniteus.com/.
At ChristianaCare, we are looking forward to fostering the growth of Unite Delaware throughout the state, and excited to see the positive impact we, along with other community providers of social services, can all achieve working together to address the social determinants of health.