Each patient is assigned to a care coordinator that is familiar with the patient’s history, strengths, needs and support system. The care coordinator and team will:
Reduce confusion for patients by navigating them through the health care and social services system.
Help patients get access to the right care at the right time, and make sure they stay connected to their providers.
- Reduce barriers to patient care and treatment compliance and connect them to support services.
- Smooth workflows with coordination and support for primary care, behavioral health, oral health and other network providers.
- Assist with patient transitions between levels of care, such as hospital to primary care.
- Help with provider navigation, including targeted high-risk case management.
- Address social determinants of health.