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Healthcare Support Services
Care Coordination

We help clients manage their healthcare.

Healthcare can be hard sometimes.

We help make it a little easier.

What is Care Coordination

Care coordination involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care. This means that the patient's needs and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care to the patient.

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Providers communicate with each other to exchange ideas and information on your specific clinical needs. This might look like sharing updates about medical and mental health diagnoses, treatment plans, treatment interventions, medications, therapeutic approaches and goals, and any other considerations that might be important for your overall health and wellbeing.

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​Care Coordination services ensure the best possible healthcare for you.

Why is Care Coordination Important

Care Coordination is identified by the Institute of Medicine as a key strategy that has the potential to improve the effectiveness, safety, and efficiency of the American health care system. Well-designed, targeted care coordination that is delivered to the right people can improve outcomes for everyone: patients, providers, and payers.

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Coordinating patients' care is important for the following reasons:

  • Current health care systems are often disjointed, and processes vary among and between primary care sites and specialty sites.

  • Patients are often unclear about why they are being referred from primary care to a specialist, how to make appointments, and what to do after seeing a specialist

  • Specialists do not consistently receive clear reasons for the referral or adequate information on tests that have already been done. Primary care physicians do not often receive information about what happened in a referral visit.

  • Referral staff deal with many different processes and lost information, which means that care is less efficient.

  • For someone struggling with a mental illness, these barriers to effective treatment become even more insurmountable.

How Does Care Coordination Work

A Care Coordinator can help you stay healthy by assisting with organizing your patient care activities. It involves teamwork among different physicians and providers to achieve safer and more effective care.

What a Care Coordinator can help with:

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  • Making and remembering appointments

  • Setting up transportation to appointments

  • Communicating with your providers

  • Answering questions about your healthcare

  • Finding new providers, such as primary care doctors

  • Advocating for services

  • Providing links to local housing resources

  • Connecting with the Department of Social Services

  • Connecting with the Social Security Administration

  • Link with other MHACG services or other community agencies for support, food, clothing, or shelter

  • Provide connections to recovery-oriented services

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Eligibility

This service is available to any adult who is eligible for Medicaid and has two chronic diseases, such as diabetes, asthma, heart disease, high blood pressure, substance abuse, HIV/AIDS or a serious mental illness.

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If you're interested in receiving this service or would like to refer someone, contact our enrollment team for assistance.

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Call us: 518.943.2591

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