Social determinants of health are fundamental to supporting medical interventions and improving health outcomes. It is important that a transformed health care system adequately address many supporting factors in addition to patients’ medical needs.

Existing literature suggests that the interaction between one's social circumstances, health behaviors, and the physical environment in which he or she lives all play important and interconnected roles in explaining underlying causal mechanisms.

There are discrete work streams integrated throughout each of the 11 projects. The workstreams are guided by operational committees which serve as advisory bodies (Clinical, Finance, and Information Technology) and workgroups which establish protocols (Housing, Workforce, Transportation, and Cultural Competency/Health Literacy). These committees develop organizational strategies, policies and procedures, advise project teams, and inform centralized services. Committee members are representative of all care settings and geographic areas.