This program gives you extra support if you have significant ongoing health concerns. Our team’s advanced nurse specialists and licensed clinical social workers work with your primary care provider or specialist to give the caring support you need to improve your health and wellbeing.

How the program works

What to Expect:

We will call you to get to know you better and understand your healthcare challenges.
We will help you figure out your health goals and give you support and resources to reach those goals.
We will talk to you on the phone or by video calls two or three times a month to see how you are doing and find out if you need more help.

Our Nurse Will:

Help you understand your health conditions and how to best take care of yourself.
Review your medicines with you to make sure you can get them and know how to use them correctly.
Make sure that your primary care provider and specialists are working together to take care of you.

Our Social Worker Will:

Connect you to services and programs that help you stay healthy, safe, and able to do daily activities.
Coordinate resources to help make sure that you have what you need at home, like food, transportation, and medical equipment.
Offer support and advice to you and your family and teach you ways to handle stress and new skills for coping with challenges.