Data-Driven Approach

Our Care Management Platform and the electronic referral networks that we manage give us a complete view of our clients’ health journey. Through our data tracking systems, we integrate all programs and reports, collaborate with other agencies, decrease duplication of services, and quickly customize care plans to improve health outcomes and meet the unique needs of our clients.

Integration and Collaboration

Guided by our mission, we work with public and private programs and systems to connect people to the services they need to improve health and quality of life. We are leaders in creating data reporting and sharing systems that allow collaboration across organizations to address social determinants of health.

Shared Care Plan

As a partner of California’s Health Homes Program, and a leading partner for the City of Sacramento’s Whole Person Care program, known as Pathways to Health + Home, our Shared Care Plan portal is a multi-faceted data infrastructure used by all partnering organizations, including community agencies and clinics.

The portal allows for data mining and analysis to drive services, improve cross-organizational care coordination activities, and improve health outcomes.

Sacramento Community Network

Working with Unite Us to host our Sacramento Community Network, this collaborative referral tool helps to improve clients’ overall wellbeing and address social determinants of health. Agencies linked to a client can view their client’s referral history, including current status and updates on services provided.

Since our launch in April 2020, we continue to see development in new partner relationships, an increase in users, and expansion of the platform throughout the Greater Sacramento Region.

My Navigator Resource List

Our My Navigator Resource List uses the Aunt Bertha platform as a referral and community resource tool to connect people to health and social care. Through this online tool, any community member can find preventative and primary care, wellness programs, food, and other health resources. Straight from their device.

Since our launch in 2017, we have received 962 referrals from various organizations.