FREE program to help connect residents to medical and social services throughout the community.
Every client is partnered with a Community Health Worker (CHW).
CHWs provide wrap-around services to help clients take charge of their health and achieve their personal goals.
This is a new program that connects residents with a Community Health Worker (CHW) who provide wrap-around services to address an individuals’ medical and social service needs.
Do you need help with:
Other Basic Needs
Finding a primary care doctor or behavioral health services
Understanding the healthcare system and using insurance
FCPH is part of the Central Ohio Pathways HUB
The HUB is managed by the Healthcare Collaborative of Greater Columbus. Different from other referral networks or programs in Ohio, the HUB tracks risks, connections and outcomes via “pathways” and a specialized technology system. Community Health Workers (CHWs) working at Care Coordination Agencies (CCAs) work hand-in-hand with clients enrolled in the HUB to attain success in completing pathways; successful outcomes (“completed pathways”) have payments associated. By providing this innovative model to Franklin and contiguous counties, HCGC continues its mission to increase optimal health for all in our region; reduce duplication and variation of services; increase health and healthcare value by proactively addressing social determinants of health and connections to care; and increase health equity in Central Ohio.
How It Works
CHWs enroll clients in the HUB. Healthcare providers and others refer clients to the HUB.
Once enrolled, clients complete a comprehensive assessment to identify health and social service needs (risks).
CHW works with their supervisor to develop a plan of care based on the identified risks. Each risk translates into a standardized Pathway.
4. Problem Solve
CHWs meet regularly with clients in their homes to build trusting relationships and offer support. Behavioral change is supported through the use of Learning Modules.
HUB staff reviews data on a regular basis to ensure that clients receive a high quality and meaningful experience. The HUB works to reduce duplication of services and identify community gaps in resources.
HUBs bill Medicaid managed care plans and other funding partners for successfully completing Pathways. HUBs distribute payments to the organizations that employ CHWs. HUBs keep a small administrative fee.