This team works with your primary care provider to help you stay healthy.

Our friendly Health Care Navigators (HCNs) reach out to you if you are missing important health screenings and check-ups and schedule appointments for care such as such as blood pressure readings, diabetes testing, cancer screenings, and Well Child visits. We also teach you why it’s important to check for tobacco use and Advance Care Planning (ACP). We will also ask you about social needs that impact your health and wellbeing, like housing and food.

How the program works

First Phone Call

You will receive an automated phone call if it’s time for an important health screening or checkup that you have not done yet. During this call, you can choose to get help from our team.

If you suspect you are due for a health screening, checkup, or appointment, and have not heard from us, call your primary care doctor.

Getting Help

• A Health Care Navigator will reach out to you to:
  • Review your medical record to see what health screening or care is needed
  • Help you in setting up an appointment with your Primary Care Provider, with radiology, or specialists to get the care you need
  • Ask if you need help with getting your medicines refilled
  • Ask about other things in your life that might be making it hard for you to stay healthy. We can tell you about community resources that can help you.

Keeping Up with Your Health

• This program will keep track of you over a long time. After you complete these important screenings, we will remind you when it’s time for the next one. If you think you are due for a health screening, checkup, or appointment and have not heard from us, call your primary care doctor.
• If you don’t complete your screening, we will check in with you again in three months.