A patient-centered approach to integrating health and social support services that are necessary for a healthy life and lifestyle.
- Act as primary point of contact for patients and caregivers
- Assess the individual’s needs and wishes
- Create a plan for moving forward based on those needs and wishes
- Implement the plan
- Monitor the plan and make changes as needed
- Medicaid/Medicare help
- Organize Patient’s medical records
- Work to eliminate duplicative healthcare processes
- Timely physician appointments maintained