Ecosystem Community Learning Collaborative Application

The National Center for Complex Health and Social Needs (National Center), with support from the Robert Wood Johnson Foundation, is convening a results- and action-oriented learning collaborative to support organizations in developing and strengthening "ecosystem" approaches to serving the root cause needs of medically and socially complex populations. Complex care ecosystems are composed of organizations across sectors within a community, working collectively and intentionally to better impact the root causes of poor and inequitable health and wellbeing among vulnerable and often marginalized populations. At least five selected communities will receive 15 months of individualized TA and will participate in a learning collaborative consisting of all of the teams, who will share their respective experiences and mutually support each other’s efforts.

Use the form below to apply for this opportunity by January 15, 2021. If you have any questions about this opportunity or application, please contact Rebecca Koppel at rkoppel@camdenhealth.org.

Primary organization name *

Primary organization address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Primary organization website *

Project lead name *

First Name Last Name

Project lead title *

Project lead e-mail *

Project lead phone number *

Primary organization background and current activities

If applicable, please answer the following questions based on the sub-structure (e.g., division, department, program) that is running the complex care initiative and would be leading this project.

Provide a brief description of the mission, history, and population served: *

Number of people served per year: *

Describe the existing care management structure, including details such as how and where care is provided, to whom and by whom care is provided, and any results to date: *

Describe how services are paid for or otherwise financially supported: *

Describe the primary organization's current commitment to health equity and addressing root causes of health and well-being: *

Describe how consumers are meaningfully engaged in decision-making processes: *

Briefly describe any efforts the primary organization/division/program currently has in place that focus on building a complex care ecosystem and any challenges to those efforts. Please include current partners and how it is paid or reimbursed for: *

Proposed approach

Describe the goals and objectives of the project, how this work will impact the population served, how it will increase health equity, and how the proposed approach and activities will meet the stated goals and objectives: *

What is the primary organization's motivation for engaging in this work? How does this work align with the primary organization/division's larger population health strategy? *

Describe how the voice of the community and/or the individuals that the program serves will be meaningfully incorporated into the design and delivery of project activities and the delivery of services: *

Describe desired areas in which the National Center can provide technical assistance and support: *

Quality measurement

What process and outcome measures does the primary organization use now to monitor the complex care program's impact? *

Describe the primary organization/division's capacity to capture data to support monitoring and analysis of key process and outcome measures, and any challenges the primary organization may face in this area as well as suggestions for mitigating these challenges: *

Leadership and stakeholder commitment

Describe the level of commitment by the primary organization/division’s senior leadership and any other internal key stakeholders. Please provide specific examples of activities that demonstrate leadership’s commitment to this work, and how they will be involved in supporting the primary organization's efforts throughout the course of the initiative. *

Please upload a letter of support from the primary organization/division's leadership. *

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Partner organizations

Identify 2 or more partners, with a minimum of 1 partner from a different sector than the primary organization, that will be involved in building a complex care ecosystem for an identified targeted population in the community. Describe any previous and ongoing efforts and obstacles to collaboration. *

How would you describe the team's (primary organization + partners) stage of development using Bruce Tuckman's Stages of Team Development? *

Forming: working to establish expectations, develop trust, and agree on common goals Storming: identifying power and control issues, developing communication skills, and reacting to leadership Norming: working within an atmosphere of agreement on roles and problem solving processes, with decisions made through negotiations and consensus Performing: achieving effective and satisfying results, working collaboratively, and caring for each other

Upload letters of support from the identified partners. *

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Organizational capacity

Describe the proposed project management approach and list the implementation team including names, titles, short summaries of qualifications, percentage of time allocated to proposed initiative, and roles of all members: *

Indicate how the primary organization plans to sustain the work initiated after the technical assistance and learning collaborative end: *

Discuss any anticipated challenges that may arise during this project and how they might be mitigated: *

Is the primary organization willing to participate in data sharing, tool and resource sharing, and codification of findings for the advancement of the complex care field? *

Yes No

Is the primary organization able to commit to attending the learning collaborative kick-off on May 3, 2021 and the closing retreat in June 2022? *

Yes No

Thank you for completing this application. If you have any questions, please contact Rebecca Koppel at rkoppel@camdenhealth.org.