Systems of Care Initiative, Inc. (SOCI) was formed on January 1, 2010 as a community based organization and implemented a transitions of care program on April 1, 2013. By 2015, the program had been implemented in four hospitals in Northern Colorado (Loveland (2), Fort Collins and Greeley.)
Initially, the program focused on hospital referrals for a transitions of care program and later accepted referrals from post-acute facilities and from primary care providers. The transitions of care program focused on patient engagement and empowerment at any time, not just post hospitalization. The program reduced hospital readmissions. SOCI's board decided to use the SOCI coaches for the advance care planning program following Medicare's decision to discontinue funding for transitions of care programs. SOCI provides free advance care planning to people living in Fort Collins, Loveland, Greeley and surrounding communities.