Connecting Care Where It’s Needed Most
Standing in the Gap: A Program for Educational Support, Wellness & Care
Our Community Health Workers (CHWs) bridge the gap between healthcare systems and the people who need care most, improving outcomes and reducing barriers for Medi-Cal and Medi-Caid members.
How CHWs Make an Impact
HHN’s CHWs engage directly with members, identify needs, provide medical education, and connect individuals to medical, behavioral, and social services. Our CHWs are highly trained to provide trauma-informed support through motivational interviewing so they can build relationships across all backgrounds.
Member engagement through home visits, phone calls, and field outreach
Provide chronic condition education and medication adherence support
Coordinate with medical, behavioral, and social service providers
Assist in accessing housing, food, transportation and benefits
Provide guidance for preventive care, wellness programs, and health screenings
In one CHW-led intervention, 78% of patients reported being connected (or equipped) to social services after engagement — a strong indication of impact on social stability.
— Fiori K.P. et al., “Advancing social care integration in health systems with community health workers” BioMed Central
How We Serve These Important Populations
- Identify high-need members and overdue care gaps
- Improve appointment adherence and follow-ups
- Collect real-time social and health data for personalized care planning
- Facilitate communication between patients, providers, and community services
- Support members who are historically hard to reach
Would you like our CHW program to help extend your practice or care teams?
CHWs meet people where they are - in their homes, schools, shelters, and neighborhoods - connecting them to the care and resources they need to thrive.
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