Patient Care Intervention Center

Newsletter

2024 Year-in-Review Newsletter

Dear Friends & Supporters of PCIC:

As we settle into 2025, we want to thank you for being part of PCIC’s journey toward a healthier and more equitable future. In 2024, we achieved meaningful milestones that reflect our shared commitment to transforming lives and bridging gaps in care. Read Newsletter

Design and Framework of a Technology-Based Closed-Loop Referral Project for Care Coordination of Social Determinants of Health

lady justice

PCIC CEO Kallol Mahata co-authored a new publication in Population Health Management, "Design and Framework of a Technology-Based Closed-Loop Referral Project for Care Coordination of Social Determinants of Health."

Screening for social determinants of health (SDOH) has been mandated by health systems nationwide. However, a gap exists in closed-loop referral for care coordination between health care and social services. This article presents the framework of a technology-based project to facilitate closed-loop referral between health care and social service agencies in Greater Houston by leveraging and connecting the existing care coordination technology infrastructure. Ten health care and social service organizations in Greater Houston participated in the demonstration project initiated in January 2023. The authors leveraged and linked regional health information exchange (HIE) technology with a master patient index of >18 million, and sector-specific care coordination platforms to build closed-loop referral capacity between HIE-participating health care organizations and social service organizations to meet patient SDOH needs. Evaluation efforts will assess the reach, adoption, implementation, and the effectiveness of the closed-loop framework in improving social and health outcomes. Read Article

Hurricane Preparedness Tips: Essential Steps for Staying Safe

hurricane on Earth

As a nonprofit committed to leveraging health data and technology to improve patient outcomes, the Patient Care Intervention Center (PCIC) team understands the importance of being prepared for emergencies. In Texas and other coastal regions, hurricane season can disrupt not only daily routines but also critical health services, making preparation crucial for individuals, families, and healthcare providers alike.

To help you stay safe and ready, we’ve compiled a list of essential hurricane preparedness tips to protect your loved ones and ensure that you’re ready when a storm threatens.

Reimagining Care for Vulnerable Populations: A Retrospective on the PCIC and Amerigroup Partnership

“We want to make an impact, but we don’t know if we’re helping the people who need it most, and we have a hard time tracking the long-term impact of our outreach team’s interventions.” Sound familiar?

PCIC can help—for example, our data-driven interventions in partnership with Amerigroup in 2023 led to a 75% reduction in hospital visits, a 72% decrease in healthcare costs, and a reported 12% improvement in quality of life for the enrolled patients.

These outcomes highlight PCIC’s ability to act as not just a partner, but an extension of our partners' teams, enabling you to maximize your resources with proven strategies that make a tangible impact.

Health & Homelessness in Houston: PCIC Partners with Dr. Ben King of UHCOM to Understand Harris County Homelessness Mortality

Mortality rates are increasing for people experiencing homelessness in Harris County, and we need to learn more about why and how to help.

Patient Care Intervention Center (PCIC) is partnering with Dr. Ben King of the University of Houston Tilman J. Fertitta Family College of Medicine (UHCOM) to understand trends in mortality rates and causes of death among people experiencing homelessness in Harris County.

Breaking Down Nutrition Barriers: PCIC and UHCOM Partner to Improve Access to SNAP in Houston’s Third Ward

Healthy meals make a huge impact. In fact, poor nutrition is the main cause of poor health, high healthcare costs, and lower productivity in the US and globally. It leads to health issues like heart disease, cancer, and other serious conditions (Source: American Heart Association).

That’s why Patient Care Intervention Center (PCIC) is partnering with the University of Houston Tilman J. Fertitta Family College of Medicine (UHCOM) in 2024 to break down barriers to nutrition in the Houston Area by improving access to Supplemental Nutrition Assistance Program (SNAP) in Houston’s Third Ward.

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Our Mission

Humanize health equity by integrating clinical, behavioral, and social determinants of health into serviceable insights that our partners use to drive action, putting each individual on a path toward achievable health and well-being.

We Envision

Creating a new reality of integrated effective care that will transform the lives of all people, especially vulnerable populations – a beacon for True Health Equity.

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