Patient Focused Solutions
We provide support to patients, no matter where they are on the care continuum. From wellness and prevention education to complex care management, we use highly skilled and experienced health care professionals (nurse and social work care managers, community health workers, and care coordinators) to meet the patients’ needs. We use an interdisciplinary care team to provide support and services to patients, including care coordination of primary care providers and specialists. We also use technology, such as remote patient monitoring, and provide complex care management, for those patients who benefit from a higher level of support. We partner with providers and payers to identify and stratify the patient population so that we can deploy appropriated and targeted interventions. We understand the significant role that social determinants of health has on health outcomes and costs. Our model assures that every patient is screened for social determinants of health needs and our community-based care team assures that the patient is connected with the right service and educated on how to navigate the health care system to meet those needs.