Our social workers, working remotely, address the social and behavioral health needs of patients, health plan members,
and clinical trial participants
Return on Investment (ROI) = 3 dollars in cost savings from reduced hospitalizations for every 1 dollar of expense
Cost-effectively improve value, reduce health inequities, and expand inclusion by addressing social determinants of health with reliability.
Our interdisciplinary team includes bachelor- and master-level social workers. Our team has extensive experience with the patient-centered medical home model of care, value-based care, attending to heath disparities, and leading clinical trials. We offer services in English and Spanish.
Our team will assess, manage, refer, coordinate, and track patients' social and behavioral health needs. Patients will be referred to community-based services for social needs and receive behavioral health services either from their designated provider or directly from our staff. The team utilizes a customized innovative case management technology platform that ensures the highest reliability and accountability of services, is interoperable with the patient's electronic health record, and supports the real-time reporting of outcomes to our customers. We charge our customers an annual case management fee for each registered patient. Our work returns joy as well value to our customers and their staff.
Practices participating in physician-led ACOs, e.g., MSSP or ACO REACH, benefit from our low-cost remote social workers' case management and mitigation of their patients' SDOH needs. We also support practices participating in Primary Care First and Make Care Primary Medicare programs.
Insurance companies offering Medicare Advantage and Medicaid Managed Care products benefit from our proven return on investments--for every dollar invested in our services, there is a three dollar costs saving due to reduced admissions.
Health systems in need of a cost-effective social worker solution for their growing integrated care network of primary care practices find benefit in engaging our services. Those health systems with an ACO, also benefit from our ability to reduce the total costs of care.
Our social workers focused on the SDOH needs of clinical trial participants reduce attrition, increase the number of under-represented study participants reaching studies' primary end-point and increase the diversity of the final study population.
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