Care Coordination Workgroup

The Care Coordination Workgroup aims to connect Baltimore City residents to the care they need. Community members and grassroots organizations work hand in hand with healthcare professionals to share health-related social needs data and improve the way that patients connect with care and service providers.

Care coordination graphic



  1. Improve access to healthcare, services, and resources for Baltimore City residents.
  2. Improve the quality of healthcare, services, and resources for Baltimore City residents.


  • By December 2024, enhance referral pathways between health providers and community organizations.
  • By January 2025, implement 1-2 policies in support of community health workers.
  • By June 2025, coordinate the sharing of health-related social needs data across 85% of healthcare systems.


  • Convene healthcare and community partners with CRISP, Maryland’s Health Information Exchange.
  • Work with healthcare partners to identify values, needs, and challenges related to data sharing.
  • Recruit community organizations to share referral information.
  • Test data sharing methods between 2-3 organizations to build upon data sharing processes.
  • Share learnings and build community relationships through LHIC meetings.