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COMMUNITY CARE COORDINATION

Health Home CCCCO
COMMUNITY CARE COORDINATION > HEALTH HOME PROGRAM LEAD   |   HEALTH HOME CCCCO
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Community Choice Care Coordination Organization (CCCCO) contracts with Action Health Partners (AHP) to provide care coordination services in Chelan, Douglas, Grant and Okanogan counties. Through the Health Homes program, we help our most at-risk Medicaid and Medicaid-Medicare, or dual eligible, residents connect to long-term, supportive care coordination.
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What is the Health Home Program?

The Health Home Program is a community-based care coordination program that sets out to support participants who have serious chronic conditions, behavioral health conditions, and have social service needs.

 The Health Home Program provides care coordination of medical, behavioral health and long-term services and support for individuals of all ages through a person-centered approach for clients. The program aims to help clients take charge of their own health. Participation is voluntary. 

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What are the Core Services provided?

Clients who join the Health Home program are assigned a care coordinator that works one-on-one with the client and members of their care team to connect them to health care and social services they identify as needed.  A key focus of the Health Home program is to provide the participant with a key advocate to help guide the participant to better health and quality of life. 

The Health Home program provides access to six core services:
Comprehensive Care Management
  • Develop and maintain a Health Action Plan to help clients meet their health care goals and stay healthy.
Care Coordination
  • Keep all providers coordinated and up-to-date about client’s health care needs and the services they receive
Health Promotion
  • Provide information and tools to inform clients and their family members on the best ways to manage health conditions.
Comprehensive Transitional Care/Follow-Up
  • Help clients move safely and easily between different care settings, such as entering or leaving a hospital or nursing facility and returning to their own home.
Patient & Family Support
  • Include family or friends on the care team if the client chooses, so they have up-to-date information on their conditions and ways to support them.
Referral to Community & Social Support Services
  • Help clients find and apply for needed community and social services needed, including housing, food, employment, etc.

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Who qualifies for the program?

Eligibility: 
To be eligible for the Health Home program, Apple Health clients of all ages, including Medicaid/Medicare dual eligible clients, must: 
  • Have at least one chronic condition and 
  • Be at risk of poor health outcomes in the future based on age, gender and diagnoses
  • The State enrolls eligible clients with a Health Home lead organization and informs the client’s health plan that (s)he is eligible for Health Home services.
General Qualifications:
  • All ages, across all settings
  • 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.)
  • Be at risk of poor health outcomes in the future based on age, gender, and diagnoses
  • Are a Medicaid and/or Medicare client
  • Have a serious health issue that typically requires more than one service provider
  • A risk score of 1.5 or greater predicting 50% higher healthcare costs than the average Medicaid disabled client in the next 12 months

MEET OUR CCCCO TEAM

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Elaine Bandy

CCCCO Manager
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Adriana Barcena

Health Home Care Coordinator
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Alexis Rodriguez

Health Home Care Coordinator
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Bill Murray

Health Home Care Coordinator
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Darcee Anderson

Health Home Care Coordinator
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Gladys French

Health Home Care Coordinator
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Irene Sanchez

Health Home Care Coordinator
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Jeff Radford

Health Home Care Coordinator
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Laurie Holmes

Health Home Care Coordinator
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Maribel Godinez

Health Home Care Coordinator
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Midge Kirkpatrick

Health Home Care Coordinator
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Vicki Seabrook

Health Home Care Coordinator
For more information or to check for eligibility, please contact_____ or click here.  [Link to Lead Referral Form]
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Office Phone 
(509) 782-5030​
Email
admin@cc-ahp.com
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LOCATION

Main Office
230 Grant Rd. Suite A25
East Wenatchee, WA 98802​


  • Home
  • About Us
    • Our Team
    • Our Partners
  • Programs
    • Community Care Coordination
    • Health Education >
      • Blood Pressure Monitor Check-Out Program
      • Chronic Disease Self-Management
      • Chronic Pain Self-Management
      • Diabetes Self-Management
      • Healthy Heart Ambassador Program
    • Health Insurance
    • Network Support Services >
      • Chelan-Douglas CHI
      • CHNA
      • Interagency
      • MLCRF
  • Volunteer
    • Volunteer - Chronic Disease Self-Managment
    • Volunteer - SHIBA
    • Volunteer - General Volunteerism
  • Opportunities
    • Become a CCO
    • Careers
  • Donate
  • Contact
  • Blog