Improving Health & Health Care in Communities Across South Central Pennsylvania

When we began in early 2007, we didn’t have a charted course to follow or a well-marked roadmap that outlined all of the hills, valleys, skyline, turns or bumps. Instead, we had to trust each other and remain transparent about our goals and challenges, celebrating accomplishments with each step forward.

Where has the trail taken us? To start, we came to grips with the fact that the current health care system cannot operate as it has in the past if we want to achieve the Triple Aim – better care, better health and lower costs. It is not enough for patients to visit the doctor when they are sick. We must help them become prepared, empowered partners in their own care. 

This is especially important for our patients, as many of them are facing our country’s biggest epidemic: chronic disease.Diabetes, heart disease and other conditions require a lifelong commitment to healthy living every single day. But, through our work we’ve also uncovered that in many instances patients face barriers (language, transportation, time and cost), which can keep them from achieving their goals and staying healthy. To directly help patients achieve health goals, we have developed programs such as I Can! Challenge and It’s Your Health…Take Charge! that improve patient engagement and health literacy gaps. 

Additionally, we have helped patients by improving processes within providers of care; integrating community resources into health care teams; developing a strong hub of care through the Patient-Centered Medical Home Collaborative; and testing new models of paying for health care.