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Communities

Closing care gaps requires trusted community relationships — built hyper-local, one relationship at a time.


The Challenge

Relationship over transaction.

Lasting change happens in communities, not spreadsheets. HCDI builds hyper-local, culturally intelligent partnerships rooted in trust — relationships, not transactions — that reduce disparities and earn lasting credibility.

Partner locally

Work through trusted community organizations, not around them.

Assess unmet needs

Health-related social needs assessments surface non-medical barriers.

Connect to services

Referrals and follow-through that actually land.

Strengthen the workforce

HCDI helps partners meet HR1 workforce requirements with trained, community-based talent.

How we help

Sustainable, community-based interventions

Built to last beyond a single program cycle.

Trusted community partnerships

Hyper-local coalitions that earn trust before asking for anything in return.

Strategic, Data-driven Quality Improvement

Target and close disparities with data.

Culturally intelligent engagement

Connect in the language, background, and context communities’ trust


The Outcome

Trusted relationships, measurable results.

Our community model turns trusted, hyper-local relationships into sustainable, measurable quality-improvement gains.

7,997 health-related social needs assessments completed

Across communities in 2024.

Two-thirds led to a service referral

With real follow-through, in 2024.


OUR APPROACH

The HCDI Parachute® Model logo

The HCDI Parachute® Model

HCDI’s proprietary Parachute® Model builds lasting community-based interventions through a data-driven, research-informed strategy. HCDI partners with existing community assets, ensuring a sustainable, trust-driven approach to reduce health disparities, close HEDIS care gaps or address social drivers of health.

We have employed this approach with vulnerable populations nationwide on projects such as:

  • The Health Disparities Quality Improvement Organization Support Contractor (HDQIOSC) under Mississippi Health First and Every Diabetic Counts (EDC)
  • The Transforming Clinical Practice Initiative (TCPI) as a Support and Alignment Network (SAN) funded by the Centers for Medicare & Medicaid Services (CMS)
  • HEDIS Gap Closure and Non-Medical Drivers of Health initiatives for government-sponsored health plan partners.

OUR APPROACH

H.E.A.R.T. Methodology

HCDI’s Health Education Action Response Team (H.E.A.R.T.) Methodology

Our organization has decades of experience engaging hard-to-reach populations.

Using our data-driven H.E.A.R.T. Methodology, our experts identify populations most in need with the highest associated cost drivers and then develop a holistic strategy to address both clinical and non-clinical needs.

Our comprehensive population health engagement expertise improves health outcomes for communities while reducing costs.


Who We Help

Intelligence-driven. Human-centered. Built to close gaps.

HCDI helps clients identify priority populations, understand barriers to care, and activate outreach strategies that move people toward better health.

Our Work Supports

Population health management

HEDIS and Star Ratings support

Quality improvement

Care gap closure

Member engagement and retention

Risk adjustment support

Strategic Partnerships and Planning

Value-based care performance

Community-based outreach

Data-informed reporting and measurement


Build quality improvement that lasts.

Partner with HCDI to create sustainable, community-based solutions.


Partner with HCDI