In November 2024, the Center for Medicare and Medicaid Innovation (CMMI) released the third evaluation report of the Accountable Health Communities (AHC) Model, in which Medicaid and Medicare beneficiaries in 28 communities were screened for social risks and offered navigation to help resolve identified risks. The 177-page report is chock full of interesting findings. On May 8th Dawn Alley, former director of the AHC Model at CMMI and Head of Scale at IMPaCT Care and SIREN Co-Directors Caroline ...
Jul 16, 2025•51 min•Ep. 44
The closing plenary discussion at the SIREN 2025 National Research Meeting: Advancing the science of social care, occurred on February 4, 2025 and featured a conversation with health and social care leaders Damon Francis, Monica Soni, Palav Babaria, and Sanjay Basu. Speakers explored multiple social care initiatives being taken to scale and offered their insights about how to navigate this work within a rapidly changing federal policy landscape. Content from the 2025 SIREN National Research Meet...
Jul 09, 2025•1 hr 15 min•Ep. 43
This plenary session held on February 3, 2025 at the SIREN 2025 National Research Meeting: Advancing the science of social care featured a discussion between moderator Anand Shah, Vice President of Social Health at Kaiser Permanente, and panelists Stuart Butler, Scholar in Residence of Economic Studies at The Brookings Institution, and Len Nichols, professor emeritus of Health Policy at George Mason University. (Note: Dr Nichols joined virtually.) The panel explored the rapidly shifting sands of...
Jul 02, 2025•57 min•Ep. 42
The opening plenary session on February 3, 2025 at the SIREN 2025 National Research Meeting: Advancing the science of social care, featured keynote speaker Lauren Taylor, an assistant professor in the Department of Population Health at NYU Grossman School of Medicine, where she is jointly appointed in the Division of Healthcare Delivery Science and the Division of Medical Ethics. In her talk, “Whose job is it, anyway? Exploring the ethics of health care's involvement in social care,” Dr. Taylor ...
Jun 25, 2025•1 hr 5 min•Ep. 41
Medicaid community reinvestment requirements enable states to require or incentivize state contractors to reinvest in the communities they serve. State laws, waivers, and contracts that include community reinvestment provisions have specified reinvestments (using percentage of profits and/or performance measures) in community initiatives that align with the state’s key priorities, e.g., improving healthy food access. On January 14, 2025, the UCSF Social Interventions Research & Evaluation Ne...
Jun 18, 2025•1 hr 14 min•Ep. 40
SIREN was excited to partner with Futures Without Violence on a two-part webinar series this season. In the second event held on December 5, 2024, speakers shared their lessons learned about sustainable and equitable approaches to documentation/coding and intervention, which are relevant not only to intimate partner violence but also to other social drivers of health. This webinar is made possible with support from Blue Shield of California Foundation and Kaiser Permanente.
Jun 11, 2025•53 min•Ep. 39
SIREN partnered with Futures Without Violence on a two-part webinar series this season. On November 5th, 2024 speakers discussed evidence-based and healing-centered approaches for responding to intimate partner violence and share strategies shown to enable and sustain meaningful partnerships with community-based programs. This webinar was made possible through support from the Blue Shield of California Foundation and Kaiser Permanente.
Jun 04, 2025•50 min•Ep. 38
Evidence is mounting about the impacts of interventions such as medically tailored meals and produce prescriptions on diet-related health conditions, fueling interest in these interventions among healthcare organizations and payers. On June 5th at 9am PT/12pm ET we heard experts discuss the latest research in this area. Panelists included researchers Drs. Kurt Hager (UMass), Hilary Seligman (UCSF), and Ariana Thompson-Lastad (UCSF) in discussion with Dr. Monica Soni, Chief Medical Officer of Cov...
Jul 31, 2024•53 min•Ep. 37
This is the second of a two-part webinar series on implications of the Camden Coalition’s RCT results. In 2020, a major article on “healthcare hotspotting” may have caught your eye. The article described findings from our four-year, prospective, 800-person randomized evaluation of the Camden Core Model, an innovative and comprehensive approach to care coordination for patients with very high use of healthcare services. The study found no differences in hospital utilization between patients rando...
Jul 24, 2024•52 min•Ep. 36
This is the first of a two-part webinar series on implications of the Camden Coalition’s RCT results. In 2020, a major article on “healthcare hotspotting” may have caught your eye. It did ours! The article described findings from a four-year, prospective, 800-person randomized evaluation of the Camden Coalition’s Camden Core Model, an innovative and comprehensive approach to care coordination for patients with very high use of healthcare services. The study found no differences in hospital utili...
Jul 17, 2024•56 min•Ep. 35
On March 29, 2024, the Harvard Medical School Center for Bioethics convened a session of the Organizational Ethics Consortia Series on social care. Addressing health inequity generally requires attention to the most marginalized patients, whose health is often undermined by social, legal and financial challenges. In response, many health care delivery organizations have begun to collect data about health-related social needs and build organizational capacity to address these needs, either “in-ho...
Jul 10, 2024•1 hr 20 min•Ep. 34
On Monday March 11th participants joined us for a conversation about the new SIREN Social Care Conceptual Model! Emerging evidence suggests that social care programs do not affect health solely by connecting patients with social services and reducing socioeconomic barriers. In a recent paper we used this evidence to develop a model that depicts the multiple pathways through which social care interventions appear to operate. SIREN co-directors Laura Gottlieb, Danielle Hessler, and Caroline Fichte...
Jun 26, 2024•51 min•Ep. 33
Although there is no question that adverse social circumstances negatively impact health and healthcare outcomes, it is not clear what the healthcare sector’s role should be in addressing these adverse social factors. On February 28, 2024, SIREN Co-Director Caroline Fichtenberg moderated a lively discussion with three thought-leaders on their perspectives on this important question: Seth Berkowitz, MD, MPH, Associate Professor of Medicine, UNC School of Medicine Sherry Glied, PhD, MA, Dean and P...
Jun 19, 2024•52 min•Ep. 32
Social care practice and research are often inspired by intentions to advance health equity. However, social care is often planned and executed without a clear recognition of and confrontation with the racism, particularly anti-Black racism, that has led to existing inequities. While the legally-sanctioned enslavement of Black people in the United States was abolished in 1865, many of its aims have been perpetuated through residential segregation, the War on Drugs, and the school-to-prison pipel...
Mar 22, 2023•48 min•Ep. 31
Health research remains ensconced in a heavily positivist, reductionist, settler-colonial, racial-capitalist “ritual” of knowledge extractivism and expropriation wherein credentialed researchers mine marginalized communities for data to (re)package and (re)distribute as their (our) own knowledge. Much of this work has focused on racial health inequities while, curiously, leaving unexamined matters of positionality, epistemic equity, and procedural justice in the production and curation of knowle...
Mar 21, 2023•14 min•Ep. 30
Each year an increasing number of original research articles are published about healthcare-based social care programs and policies. However, relatively few of these studies measure the impact of social care interventions on different racial or ethnic minority groups. More information about differential impacts could help to improve the implementation – and ideally the impacts – of social care. During the SIREN 2022 National Research Meeting: Racial Health Equity in Social Care , physician scien...
Mar 20, 2023•34 min•Ep. 29
The final panel at the SIREN 2022 National Research Meeting: Racial Health Equity in Social Care featured four Experts by Experience (Lisa Hamlett, Mike McNear, Ann Reynoso, and Stephanie Walker) as they reflected on their takeaways from the meeting, expressed what was most important to them, and pointed out opportunities for more research and action. The goal of this session was for participants to leave the SIREN National Research Meeting feeling grounded in what mattered to patients with live...
Mar 19, 2023•40 min•Ep. 28
In this episode, Sarah Coombs, the director for health system transformation at the National Partnership for Women & Families, and Janice Tufte, an active patient partner in research, evidence generation, measurement, and care improvement, discuss their reactions to the patient and patient caregiver perspectives section of the State of the Science on Social Screening in Healthcare Settings. To read the SIREN social screening report and a bevy of related resources, visit the SCREEN Report web...
Sep 21, 2022•26 min•Ep. 27
In this episode, we are joined by Cherelle Vanbrakle, MEd, the Director of Health Promotion and Community Advocacy at People’s Community Clinic based in Austin, TX, and Andrea Nederveld, MD, MPH, an Assistant Professor in the Department of Family Medicine at the University of Colorado, to discuss the state of the science about the implementation of social screening in healthcare settings. To read the SIREN social screening report and a bevy of related resources, visit the SCREEN Report webpage ....
Sep 21, 2022•29 min•Ep. 26
In this episode, we are joined by Jaedon Avey, Health Program Analyst, and L’aakaw Eesh Kyle Wark, Researcher, both of whom are from the Southcentral Foundation in Anchorage Alaska, a non-profit, tribally owned and operated healthcare organization serving 65,000 Alaska Native/American Indian peoples in urban and rural communities across over 100,000 square miles of Southcentral Alaska. Emilia De Marchis talks with Jaedon and L’aakaw about screening for patient assets – not just risks – in health...
Sep 21, 2022•39 min•Ep. 25
SIREN Senior Research Associate Yuri Cartier, MPH, sits down with Kalpana Ramiah, DrPH, MSc, CPH, Vice President of Vice President of Innovation at America’s Essential Hospitals and Director of the Essential Hospitals to discuss SIREN’s recent review of surveys measuring the prevalence of social screening activity in different health care settings in the United States. Dr. Ramiah shares how the review’s findings can be used by essential hospitals, and what other considerations and challenges rem...
Sep 21, 2022•21 min•Ep. 24
In this episode, Andy Quiñones-Rivera, MD, MPH, an ER resident physician with LA county is joined by Loel Solomon, MPP, PhD, a Professor of Health Systems Science at the Kaiser Permanente School of Medicine and former Vice President for Community Health at Kaiser Permanente. The two explore the evolution of healthcare providers’ perspectives on social screening and what this means for the future of social care practice. Their discussion also begins re-imagining the roles and responsibilities of ...
Sep 21, 2022•27 min•Ep. 23
On December 3rd, 2021, SIREN organized a special closing event (insert tears) for the 2021 Coffee & Science series. Special guests Bethany Hamilton, JD, and Kelly Doran, MD, shared their own takeaways from the series and asked participants to share favorite episodes and raise big-picture questions about how social care research can be used to move the needle on policy and practice. Reminder! Please let us know what you thought of Coffee & Science and your ideas for SIREN’s 2022 National ...
Dec 13, 2021•28 min•Ep. 22
This episode features a conversation between Damon Francis, MD, Medical Director of the Homeless Health Center in the Alameda Health System as well as Chief Clinical Officer of Health Leads, and Noha Aboelata, MD, Chief Executive Officer and co-founder of the Roots Community Health Center in Oakland, California. This is the last in a series of six Coffee & Science events on topics related to Alignment and Advocacy, which are both about what health care can do at the community level to addres...
Nov 30, 2021•28 min•Ep. 21
This episode features a conversation between Nessia Berner Wong, MPH, Senior Policy Analyst at Change Lab Solutions, and Lauren Poor, MPH, a Regional Program Manager with the Healthy Food in Health Care program at Health Care Without Harm. This is the fifth in a series of six Coffee & Science events on topics related to Alignment and Advocacy, which are both about what health care can do at the community level to address social conditions. This conversation explores Healthcare without Harm’s...
Nov 16, 2021•25 min•Ep. 20
This episode features a conversation between Bich Ha Pham, JD, the Director of Communications and Policy at the Healthcare Anchor Network, and Mike Koprowski, MA, Ed.M, who is the National Campaign Director at the National Low Income Housing Coalition. This is the fourth in a series of six Coffee & Science events on topics related to Alignment and Advocacy, which are the last two “A”s of the National Academy of Medicine’s framework that SIREN has used to organize Coffee & Science. Alignm...
Nov 02, 2021•25 min•Ep. 19
This episode features a conversation between Kelly Kelleher, a pediatrician and Vice President for Community Health and Community Health Services Research at Nationwide Children’s Hospital, and Reverend John Edgar, who is the Executive Director and Pastor Emeritus at United Methodist Church & Community Development for All People. This is the third in a series of six Coffee & Science events on topics related to Alignment and Advocacy, which are the last two “A”s of the National Academy of...
Oct 19, 2021•27 min•Ep. 18
This episode features a conversation between Wylie Liu, MPH, MPA, Executive Director of the Center for Community Engagement at the University of California, San Francisco, and Darlene Oliver Hightower, JD, Vice President, Community Health Equity at Rush University Medical Center. This is the second in a series of six Coffee & Science events on topics related to Alignment and Advocacy, which are the last two “A”s of the National Academy of Medicine’s framework that SIREN’s used to organize Co...
Oct 04, 2021•26 min•Ep. 17
This episode features a conversation between two health center-based community organizers: Hilary Mar Lopez Nichols, from Oregon Health Sciences University Family Medicine Clinic at Richmond, and Toffer Lehnherr, from Partnership Health Center in Missoula, Montana. This is the first in a series of six Coffee & Science events on topics related to Alignment and Advocacy, which are the last two “A”s of the National Academy of Medicine’s framework that SIREN’s used to organize Coffee & Scien...
Sep 21, 2021•28 min•Ep. 16
This episode features a conversation between Emmy Ganos, PhD, Senior Program Officer at the Robert Wood Johnson Foundation and Stacie Dusetzina, PhD, Associate Professor of Health Policy and Ingram Associate Professor of Cancer Research at Vanderbilt University Medical Center. This session is the last of four talks focused on health care sector efforts to Adjust clinical care based on information about patients’ social circumstances. In this conversation, Emmy and Stacie dive into the implicatio...
Sep 08, 2021•26 min•Ep. 15
