PCIC has been developing and providing innovative approaches to Care Coordination, Population Health and Health Information Technology. Here is a look at PCIC as we evolved over the years, and the history of our parent organization – Healthcare for Special Populations.
Established
Health Care for Special Populations (HCSP) was founded by David Buck, James Turley and Kallol Mahata as a 501(c)(3) nonprofit organization, to provide resources and serve the needs of vulnerable populations.
Evolved
HCSP developed one of the first web-based Electronic Medical Record System in the country, for street outreach program, using a Goal Negotiated Care model.
Grants
We gratefully received initial funding support from the Edith & Robert Zinn Foundation, Rockwell Fund and the Baxter Trust Fund.
PCIC launched
The Primary Care Innovation Center (PCIC) was launched with the purpose of developing a care coordination pilot program to improve quality of life for emergency room (ER) and hospital Super-users, while dramatically reducing their high utilization and costs to the health care system.
First stakeholder meeting
PCIC held its 1st Community Stakeholder meeting. Read more about it here.
Grants
We gratefully received funding from the Cullen Trust for Healthcare, Episcopal Health Foundation, Houston Endowment, Meadows Foundation and the Rockwell Fund.
Second stakeholder meeting
PCIC held the 2nd Community Stakeholder meeting.
First client graduated
PCIC celebrated the graduation of our first client.
Third stakeholder meeting
PCIC held the 3rd Community Stakeholder meeting.
PCIC Graduate Day
“PCIC Graduate Day” was recognized by City of Houston Mayor, Anise Parker.
Read moreGrants
We have received generous funding support from the Cullen Trust for Healthcare, Episcopal Health Foundation, Houston Endowment and the Rockwell Fund.
Rebranded
To better describe our organization’s efforts, the name was changed to Patient Care Intervention Center.
Fourth stakeholder meeting
PCIC held the 4th Community Stakeholder meeting.
Media presence
PBS NewsHour did a segment on healthcare hotspotting that features Patient Care Intervention Center and our partners at the Camden Coalition of Healthcare Providers. Read the article here.
New home
We celebrated moving into our new Houston home! In light of the move, several team members shared their memories about how PCIC has evolved over the years. Read them here.
Scaling
We ramped up efforts to scale our operation to accommodate a national audience, including expanding our telehealth platform and introducing new programs.
Unified Care Plan
The Unified Care Plan (UCP) “street outreach” program was introduced to mobilize our platform to serve homeless populations in real time.
Working with educators
PCIC collaborates with the University of Houston Graduate School of Social Work to initiate the “Healthy Start” program, a national program that helps improve the lives of mothers, infants, and families throughout the pregnancy process. This partnership will also integrate the values-based care approach into the curriculum for future healthcare professionals.
Publications
We published two scientific papers in “Population Health Management” and “The Journal of the Poor and Undeserved” in consecutive months about the need for values-based interventions in patient engagement for individuals with complex needs.
Maternal Health Integration
PCIC partnered with Healthy Start and other maternal health programs to track social determinants of health and improve care outcomes.
COVID-19 Connects Launch
We collaborated with Bread of Life, Inc. to launch COVID-19 Connects, addressing food insecurity and loneliness through technology-enabled referrals.
Youth Justice Diversion
We partnered with Lone Star Justice Alliance to support youth diverted from the justice system through UCCP-enabled case coordination.
Collective Impact Forum
We presented a values-based care model with Humana and the University of Houston Community Health Worker Initiative at the Collective Impact Forum.
Houston Food Bank Integration
PCIC formed a formal data-sharing partnership with Houston Food Bank to streamline real-time referral coordination.
CIE Summit Presentation
We highlighted UCCP's cross-sector interoperability at the Community Information Exchange Summit.
Integrated Client Journey Begins
PCIC launched Phase 1 of the Integrated Client Journey (ICJ) with United Way of Greater Houston, supporting collaborative, client-centered care.
Amerigroup Outcomes
We achieved significant ER visit reductions through values-based coordination for Amerigroup clients.
Homeless Outreach with H.O.P.E. Haven
PCIC launched UCCP-powered coordination for unhoused individuals in partnership with H.O.P.E. Haven.
Family Services Coordination
We developed a referral platform for Community Family Centers to improve access to social services.
Conference Engagements
We presented PCIC's SDoH coordination model at the Texas Primary Care Consortium and Houston Methodist SDoH Symposium.
Research on Homelessness & Dementia
PCIC partnered with the University of Houston Tilman J. Fertitta Family College of Medicine to study dementia-related service barriers among the unhoused.
Support for FQHCs
PCIC partnered with Federally Qualified Health Centers to enhance SDoH screening and referrals, supported by The Cullen Trust for Health Care and Blue Cross Blue Shield of Texas.
UCCP at TPCC
We presented technology architecture and outcomes-focused care models at the Texas Primary Care Consortium.
Amerigroup ER Reductions
We reduced ER visits by 92% for a high-risk client cohort through personalized care planning using the CCC module.
Community Connects Launch
PCIC partnered with the Albert Schweitzer Fellowship to train students as patient navigators addressing social determinants of health.
Harris Health Collaboration Expands
We launched an analysis of mortality trends and criminal justice touchpoints in collaboration with Harris Health System.
Inform Texas Conference
We presented PCIC's client-centered technology at the Inform Texas Professional Education & Training Conference alongside the United Way of Greater Houston.
Advancing Food Equity
PCIC partnered with the University of Houston Tilman J. Fertitta Family College of Medicine and Houston Food Bank to address food insecurity through tailored meal referrals and data dashboards.
Maternal Opioid Program Milestone
PCIC completed Year 5 of the CMS-funded Maternal Opioid Misuse (MOM) program and secured continuation for Year 6.
EMS Collaboration
PCIC partnered with Harris County Emergency Services District 6 / North Channel EMS to extend care coordination into emergency medical response.
OD2A Partnership Expansion
We expanded our collaboration with Harris County Public Health’s Overdose Data to Action team to analyze recidivism and overdose risk using integrated data.