COMMUNITY CARE COORDINATION
Action Health Partners works to improve regional health outcomes through community-based care coordination. Through community-based care coordination a person-centered approach is utilized by Action Health Partners and contracted partners that work to connect individuals to a full range of services and encourage them to achieve goals to achieve greater wellbeing. Action Health Partners provides the Health Home program as a Lead entity and a Care Coordination Organization.
Health Home Program
The Health Home program is not a place, it is a set of services supporting eligible clients. It is a community-based care coordination program that sets out to support participants who have chronic conditions, behavioral health conditions, and have social service needs.
The program provides care coordination of medical, behavioral health, and long-term services and support for individuals of all ages through a person-centered approach. The program aims to help clients take charge of their own health. Participation is voluntary.
SERVICES PROVIDED
Care Coordinators work one-on-one with clients to achieve goals, reduce gaps in services, and increase coordination between all types of service providers. The program aims to provide the client with an advocate to help guide the client to better health and quality of life through six Health Homes services.
Referral to community and social support services:
Connects clients to a broad range of benefits and community resources (e.g. transportation, food, housing, etc.)Individual and family support:
Identifies and recognizes the role families, informal supports, and caregivers provide in supporting client’s health goalsHealth promotion:
Supports and assists clients to reach their identified health goals and improve quality of lifeCare coordination:
Coordinates and communicates with providers to identify gaps in care and help remove barriersComprehensive care management:
Improve self-management of chronic conditions through individualized health goals and action stepsComprehensive transitional:
Supports transitions from inpatient facilities to other levels of care (e.g. from nursing facility/hospital to home)
Eligibility
Apple Health clients of all ages, including Medicaid/Medicare dual eligible clients, may be eligible for the Health Home program if they:
Have at least one chronic condition and are at risk for a second one (e.g. asthma, diabetes, kidney or liver disease, heart failure, mental health conditions, substance abuse, obesity, etc.)
Are at risk of poor health outcomes in the future based on age, gender, and diagnoses
Additional requirements may apply.
Referral
For more information or to check for eligibility, please fill out the form below or contact us at:
509-630-6033
Referral Form - Coming Soon!
Lead Health Home Network
Action Health Partners (AHP) is a lead organization for the Health Home program. AHP facilitates a network of organizations, Care Coordination Organizations (CCOs), that provide services to Health Home eligible clients. Our provider network includes multilingual and multidisciplinary staff. Services are provided in Adams, Chelan, Douglas, Ferry, Grant, Lincoln, Okanogan, Pend Oreille, Spokane, Stevens, and Whitman counties.
Aging & Long Term Care of Eastern Washington
County served:
Spokane
Frontier Behavioral Health
County served:
Spokane
Rural Resources Community Action
Counties served:
Ferry, Grant, Lincoln, Okanogan, Pend Oreille, Stevens, Whitman