The R&R Blueprint

You cannot automate coordination
that does not exist.

Health systems across the country are investing in AI-powered navigation, predictive analytics, and population health platforms. Many of these tools are being deployed on top of infrastructure that was never integrated in the first place. Clinical systems and community-based supports operate in parallel, not in coordination. The result: technology that optimizes within siloes, rather than across them.

The R&R Integration Blueprint is our signature consulting framework and a phased engagement model designed to meet you where you are and build something that lasts and reflects your unique community. It builds the connective infrastructure between clinical, community-based organizations, and the social support systems that determine whether patients actually get what they need after they leave the exam room.

The Blueprint is not a program. It is infrastructure. It works across three dimensions:

  1. Systems Integration Readiness. Where are the gaps between your clinical operations and community-based supports? What is connected, what is running in parallel, and what is missing entirely? It starts with a structured assessment that maps the current state before prescribing the next one.

  2. Integration Architecture. Design the workflows, data pathways, referral structures, and accountability mechanisms that connect clinical and community systems. This is the layer that has to exist before AI can do what health systems are asking it to do.

  3. Sustained Alignment. Integration is not a project with an end date. The Blueprint builds in the governance, feedback loops, and measurement structures that keep clinical and community systems aligned over time, not just at launch.

This framework was built from lived experience navigating fragmented systems as both a systems strategist from a career spent at the intersection of policy, community-based support, and systems change and as a patient.

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Most organizations begin with See the Spark (a 6-8 week engagement that gives your leadership team the clarity to make confident decisions before committing to a larger investment.

  • This is where clarity becomes strategy.

    Create executive clarity about where supportive care, community integration, and performance are misaligned and what it is costing your system.

    This is where most clients start. It’s also where the most important decisions get made.

    Includes:

    • Supportive care and navigation readiness assessment.

    • Current-state mapping across clinical and community systems.

    • Identification of unmanaged risk.

    • Executive briefing and decision options.

    Best For:

    • Health systems entering or expanding their value-based contracts, oncology or chronic care programs, and leadership teams seeking clarity before investing.

  • This is where strategy becomes a system.

    Translate insight into a clear, actionable operating model for whole-person care.

    Includes:

    • Supportive care and navigation model design.

    • Community partnership architecture and workflows.

    • Closed-loop referral and accountability framework.

    • Alignment to value-based metrics and performance goals.

    • Phased implementation roadmap.

    Best For:

    • Organizations ready to move beyond pilots and align supportive care with enterprise strategy and board expectations.

  • This is where systems become reality.

    Ensure the strategy takes hold and functions in real-world conditions.

    Includes:

    • Implementation sequencing and execution support.

    • Internal alignment and change management.

    • Community partner onboarding and integration.

    • Governance and accountability setup.

    • Real-time trouble shooting and refinement.

    Best For:

    • Health systems with clear direction, but limited capacity to operationalize complex, cross-sector initiatives.

  • This is where results become renewable.

    Demonstrate impact, optimize performance, and sustain results over time.

    Includes:

    • Performance tracking aligned to value-based metrics.

    • Utilization, quality, and equity analysis.

    • Continuous improvement cycles.

    • Executive and board-ready reporting.

    Best For:

    • Organizations managing long-term risk, board scrutiny, or enterprise-level value-based accountability.

  • Supplemental services are layered in as needed to accelerate implementation, deepen alignment, or respond to emerging challenges.

    Executive & Board Advisory: Board & C-Suite briefings, value-based risk and governance advisement, or decision support for major investments or partnerships.

    Community Partnership Development: CBO readiness and capacity assessments or backbone and convening support for cross-sector collaboratives.

    Navigation & Workforce Design: Navigator role design and competency frameworks, training and onboarding support, or workflow optimization across teams.

    Equity and Access Strategy: Equity-centered design facilitation, identification of structural barriers and access gaps, or community-informed strategy development.

    Technology Enablement (Non-Vendor): Data sharing and feedback loop design.

    Facilitation & Strategic Convening: Cross-sector planning sessions, community and stakeholder convening, or strategy retreats and design sprints.

Service Packages

Let's Talk About Your System
Let's Talk About Your System