Convenes coordinated care team meetings that may include representatives from hospitals, local mental health authorities, and treatment providers, residential facilities, home care agencies, federally qualified health centers, homeless outreach teams, substance use disorder treatment organizations, social services, health departments, city agencies, and housing providers. Facilitates ongoing collaboration among hospital and community service providers to reduce service duplication, optimize resource utilization, enhance care coordination, and outreach efforts, connect individuals to providers addressing health-related social needs, and share aggregate outcome data to drive improved outcomes.