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Social needs are health needs

Our single largest aspirational goal for the MassHealth ACO Program is to alleviate health-related social needs. - Christina Severin, President & CEO

Creating conversations between members, healthcare providers, and community-based social service organizations in order to address the challenges getting in the way of a member’s health and wellbeing – their health-related social needs – is doing primary care well.

At C3, the Flexible Services Program gave us a way to do just that. Critical to our success is the investment in partnerships. We do not simply refer our members to the social services sector for support. Rather, we invest new funds in ways that allow our partners to build upon their deep roots in serving communities. Here you can learn more about this model and our approach, hear from our social service partners, and get tips and ideas to advance your members’ and community’s health-related social needs.

Community Care Cooperative (C3) is a MassHealth ACO created by Federally Qualified Health Centers (FQHCs) to transform the health of underserved communities. C3 includes a network of partner FQHCs and Affiliated Providers across Massachusetts.

The Opportunity

Massachusetts’ Medicaid waiver was an opportunity to rethink primary care delivery.

Learn how we leveraged the Flexible Services Program to address health inequities by meeting the health-related social needs of our members through holistic, community-based care.

Our Approach

We partnered with trusted community organizations that were already skilled in serving social service needs.

Explore how we invested in partnerships with community organizations to facilitate closed looped referrals, ensuring members’ health-related social needs are met.

Our Impact

Members are at the center of our work.

Learn how the Flexible Services partnerships allowed mission-aligned health care and community partners to meet members’ health and social needs.


Wondering how you can play a pivotal role in the future of health care?

Consider some of these ideas for inspiration on how to use a similar model to address health inequities. Tips and ideas for both health care and social services partners are featured.

In the first two years of the program, we have served more than 7,000 members and continue to reach more and more people.

We've helped members from community health centers improve their food security or housing situation. Our members are incredibly diverse, speaking over 22 languages and representing many ethnic/racial groups.


connected with a housing expert:

We've provided intensive individualized support to address housing-related needs, such as resource navigation, application assistance, job training, income maximization, home modifications, and housing search and placement.


supported with nutrition services:

We've provided members with over $4.5M in food vouchers, 200,000 home delivered meals, and kitchen equipment and nutrition education to help members purchase, prepare, and store healthy foods.

Meet our team

Connect with us to learn more about our experience in co-designing a program to address health-related social needs.

See our team