CCC Program & Design

The Next Frontier in Healthcare Innovation

In addition to access to our standalone service offerings (i.e., Isthmus™, CVC online dashboard, and CCC Playbook), PCCI provides organizations with specific engagements that yield additional strategic insights (both data-oriented and operational) to achieve SDOH-based healthcare transformation.

PCCI’s ability to link clinical and community-based insights to create a holistic view of needs/opportunities is one of our core strengths. Our analysis integrates three layers of information: (1) the foundational SDOH-based community vulnerability insights at the census tract or block group level using four comparable vulnerability clusters, (2) patient-level hot spot data as an overlay (via client provided data), and (3) geolocations of relevant services― visually showing proximal locations of services relative to patient or community need. By doing this, we are able to help organizations address questions such as:

  • How many of our patients reside in high vulnerability neighborhoods and for these neighborhoods what are the most dominant SDOH needs?
  • What are the root causes (or drivers of) of access challenges facing our patients?
  • Do our patients live in reasonable proximity to vital services so they can effectively access them? What resources are closest to patients? Where are our competitors located relative to our patient population? Are there access barriers that would impede new programs, particularly digital health initiatives? Are there disease-based insights supporting new clinic locations?
  • How do SDOH factors directly impact key decisions around new health initiatives?

Engagements to integrate SDOH and clinical data using AI/ML processes to help providers develop more holistic, patient-centered programs.

The true potential for digital health is about the systemic ways that digital tools and approaches support individuals (based on personal preferences) in their effort to take advantage of new access points or benefit from novel, technology-enabled engagements. Through advanced analytics and AI/ML processes, PCCI has developed novel methodologies to seamlessly integrate large amounts of clinical and social data in order to gain contextualized insights into clinical, personal, and behavioral characteristics of patients. Traditional clinical programs (e.g., those targeting a specific condition like diabetes) may not address the complex needs of patients, particularly with respect to barriers to health care access (e.g., transportation barriers). This can impact long-term health outcomes. By integrating clinical and social data, providers can create programs that are more patient-centered and tailored to individuals, encourage better provider-to-patient, patient-to-provider, and patient-to-patient connections and support, and incorporate more access points (e.g., virtual and in-person).