Integrating Systems at Scale: Coordinating Health Care in Houston

This case concerns the Patient Care Intervention Center (PCIC) a values-based health technology social enterprise in Houston, Texas. This organization was founded to tackle fundamental problems in social and health services in the United States. It was initially focused on homeless superusers of the health system, that received inadequate care at high cost, notably through frequent use of emergency rooms. However, it became clear that this was only a symptom of broader system issues, especially around coordination failures across siloed health and social services and failures in case management. PCIC designed an approach that integrated two innovative features: values-based client diagnosis and case management, based on the values, concerns, and aspirations of individual clients, and a platform-based approach to sharing data both on clients and services, with tailored technological solutions for individual health and social organizations. It has been highly successful both in outreach and contract growth. By 2022, 850 agencies were providing data, involving six million individuals, with some 1,500 referrals within the system each month within the Houston area. However, PCIC faced challenges in further scaling, with respect to finance for developmental needs, human resources, and the threat of competition from large private players that offered platforms that were significantly inferior in terms of tackling the underlying system failures, but potentially attractive to health and social organizations. The case frames both the strategic questions for PCIC and the challenges of changing an essentially dysfunctional system. HKS Case No. 2271.0

• Information systems