Efforts to transform the health care system are increasingly moving beyond clinical walls to address the social determinants of health and advance health equity. The Community-Centered Health Home (CCHH) model, developed by Prevention Institute, is emerging as a powerful framework for health care institutions to integrate community prevention and clinical services to improve population health and reduce health inequities. The defining attribute of the CCHH is involvement in community advocacy and systems change—a CCHH not only acknowledges that factors outside the health care system affect patient health outcomes, but actively participates in improving them. The success of this model is predicated on identifying the root causes of disease that are perpetuating poor outcomes within a community, involving relevant partners to participate in analysis and lead action, and engaging community members.

This Dialogue4Health Web Forum provides an overview of the CCHH model and how it offers a framework for community health centers and health systems at large to address the social determinants of health and health inequities in their communities in partnership with public health and community-based groups. Speakers will describe progress to date of the first CCHH demonstration project in partnership with Louisiana Public Health Institute across the Gulf Coast; and highlight specific lessons learned on moving from concept to implementation at one of five participating sites, Escambia Community Clinics, Inc.

We recommend this Web Forum for those in community health centers, health systems, and public health departments interested in bridging clinical care and community prevention to address social determinants of health and advance health equity.