Funded by Santa Fe County, New Mexico
CONNECT, based on the Accountable Health Community (AHC) model developed by the Centers for Medicaid and Medicare Services (CMS), is a systems-change model to address the social determinants of health of Santa Fe County residents. It mobilizes Navigators housed in a range of service agencies who can connect community members to services and resources across collaborating agencies.
PIRE’s evaluation team developed and is implementing a comprehensive (outcome, process and formative) evaluation for CONNECT and a benefit-cost analysis that will focus on jail recidivism, emergency transport, and hospital emergency department utilization. In addition to population health indicators, individual indicators are being collected from CONNECT participants receiving navigation including self-reported health status, self-reported mental health status, and health behaviors for the outcome evaluation.
The outcome evaluation will help to determine if Connect is achieving its desired results:
- Improving the health of county residents;
- Connecting county residents to needed health and social resources;
- Achieving cost savings by reducing criminal recidivism and utilization of emergency services;
- Strengthening of the county’s health and social safety nets; and
- Driving systemic improvements in the county’s ability to address the social determinants of health.
Our goals in evaluating Connect are to:
- Determine whether program implementation is likely to result in achievement of the program’s short, medium, and long-term goals identified in the logic model.
- Determine the degree to which Connect achieves its stated goals.
- Identify ways that Connect can become more effective in achieving its stated goals.
This mixed method evaluation includes document review and qualitative data collection with community members, city and county staff, health care navigators, and policy makers.
This evaluation should help build the evidence base to support the use of navigation (assisting people to maneuver local, state and federal health care and social service systems) to improve the health and quality of life of community members, as well as the fiscal benefit of using public monies to support a social determinants of health approach to improving community health.
For more information about Connect:
Santa Fe County: https://www.santafecountynm.gov/community_services/hhsd/ahc
City of Santa Fe: https://www.santafenm.gov/connect