Screening and Referral Subcommittee

Patient-centered medical homes address social determinants of health

The Patient-Centered Medical Home Subcommittee was established to support practice transformation across the 54 medical homes in Livingston and Washtenaw Counties that are developing and testing service delivery models to improve care management and coordination. Subcommittee members worked together to design a common tool to screen patients for social determinants of health needs.

Ongoing work

The Patient-Centered Medical Home Subcommittee is now aggregating the data from more than 75,000 well-visit patient screenings to highlight social needs across Livingston and Washtenaw Counties and to inform decision leaders who can address these needs in the years ahead.


The subcommittee, which is led by Leah Corneail from Michigan Medicine and Marti Walsh from IHA, is comprised of dedicated volunteers from IHA, Michigan Medicine, and the Huron Valley Physicians Association, as well as from a number of regional health and human service agencies.

For more information

  • Contact the subcommittee co-chairs: Leah Corneail, Senior Project Manager, Michigan Medicine at and Marti Walsh, Chief Quality Officer and Population Health Officer, IHA at
  • Contact the committee’s staff representative: Maggie Randolph, Senior Research Analyst at the Center for Health and Research Transformation,