Veteran and Military Family Care Coordination Program Evaluation and Improvement

The purpose of this initiative is to conduct care coordination evaluation and program improvement for NCServes and NCCARE360, the largest care coordination network in North Carolina. The initiative is funded through the Governor's Institute, a subcontractor of Vaya Health and North Carolina Department of Health and Human Services. The PI (Cacace) and her team work to evaluate data from current care coordination efforts for military veterans, service members, and military families across North Carolina through the NCServes and NCCARE360 networks, examining outcomes, demographic predictors, and predictive analytics to inform market growth and penetration. In addition, the team develops and implements trainings for care coordination best-practices, enhancing client care coordination capacity, and examining strengths and weaknesses of the system in an effort to support continued growth and efficacy of the program. Client outcome data are analyzed monthly, quarterly, and yearly to identify areas of growth and weakness, and the PI (Cacace) meets with NCServes, Vaya Health, and Governor's Institute leadership at least once per month to inform, train, and advise. Data are analyzed using theory-based methods using an ecological model to monitor social determinants of health in military and veteran families, and provide feedback on the quality of care coordination, provider engagement to serve military and veteran family needs, and report to community stakeholders. The goals of the initiative are to inform community members and care coordination leadership, create academic and layperson reports, field questions and feedback from the military and veteran community, and encourage continued scholarship, professional development, and training in the field of care coordination using the implementation evaluation model. Additionally, the initiative employs and trains graduate students interested in public health and healthcare services research to guide future careers in the area.