State of the art software and cloud technologies will leverage the knowledge, best practices and solid community collaborations already in place within the SPCC network to create a new dynamic SPCC Care Model.
The SPCC Care Model integrates a patient centered, community based health care home with state of the art data analytics, population health expertise, tools and technology for clinical practice management and care coordination across all providers of service.
Adopt methods of care delivery that will ensure the full scope of primary care is provided.
Ensure care is coordinated across the spectrum of services and supports provided, with full integration of primary care, community-based services and behavioral health/public sector services.
Support and facilitate formal and informal partnerships with community based organizations, social service agencies, counties, public health resources, and other services and supports providers as elements of the care delivery model.
Ensure quality care is provided.
Use data analytics to identify opportunities for patient engagement and to stratify the population to determine the care model strategies needed to improve outcomes.