Health Home: Care Coordination
COMMUNITY HEALTH CONNECTIONS
A Health Home program serving Medicaid members in Albany, Rensselaer, and Schenectady Counties in the Capital Region and Broome, Cayuga, Cortland, Madison, Oneida, Onondaga, and Oswego Counties in central New York.
Community Health Connections (CHC) Health Home is committed to being a transforming and healing presence within the community. Comprised of care management agencies across the Capital Region and central New York, CHC is committed to serving those in need through care coordination services.
How Does a Health Home Work?
Each Health Home member is assigned a care coordinator who will ask members about their health, life, and goals. Together, the member and care coordinator will make a plan to identify what kind of help the member needs right away and what can be worked on over time. These identified needs and goals can be big or small. The decision is based solely on what the member wants to share and the care they need.
Who Can Get Help?
Those eligible for Health Home services must have active Medicaid and one of the following conditions:
- Two or more chronic conditions
- OR a serious mental illness
- OR HIV/AIDS
- OR Sickle Cell Disease
No Cost to Members for Services
If eligible, someone on our team may be able to help the member:
- Stay out of the hospital
- Obtain a doctor
- Find transportation to doctor appointments
- Ensure the member's care team communicates with each other
- Help manage member's conditions to be healthier
- Make sure members have what they need after being in the hospital
Interested in talking to someone about Community Health Connections Health Home?
How Can Health Homes Help?
By building relationships outside of office walls, care coordinators provide support, advocacy, and education to the members served as well as their families. Care coordinators connect members with needed medical, behavioral, and social services to support their overall health and wellness and assist members transitioning back into the community from hospitals, inpatient psychiatric settings, or incarceration!
