1) How did you decide on the workforce needed to address SDoH?

In our state of Pennsylvania, we current are engaged in a patient centered medical home (PCMH) learning network of community health centers across the state. There have been several topics that range from care coordination and hospital follow up, community health workers, and SDoHs at our reoccurring learning meetings. This initiative is being pushed by the state onto MCOs to drive more value based care, and has shifted several incentive program and added requirements to screen for SDoH onto CHC such as mine. More recently at a conference with the network, we are expected this year to begin coding ICD codes for SDoHs. We’ve begun efforts it screen by implementing the PRAPARE screening tool in our enrollment tablets, and plan to add these codes in our EHR soon as well.

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