Patient-Centered Services

Improving health outcomes by putting people first.

All our programs and services are complementary, coordinated, and integrated to help people get the wraparound services they need, including medical, behavioral, dental, vision, specialty, and social services.

Meeting Clients Where They Are

Our diverse team of Community Health Workers, Health Navigators, and Patient Navigators is committed to helping people achieve their health goals, and we are proud of the difference we are making in the lives of our clients. We provide personalized and culturally responsive support to help individuals overcome barriers to care, connect to needed services and navigate complex systems.

Our team works in schools, hospitals, clinics, shelters, employment centers, jails, and more.

Improving Health Outcomes

0 Health and Hospital Navigation

services provided in 2021, including enrollment into Medi-Cal and Calfresh, scheduling primary care and specialty care appointments, mitigating barriers to care, and connecting to community resources.

0 Field-Based

services provided in 2021 to support individuals experiencing homelessness and/or have complex health issues access and manage their health, housing and other social care.

0 Individuals Served

in 2021.

0 Total Services in 2021

Team-Based

Our Community Health Workers, Health Navigators, and Patient Navigators all work together to ensure clients receive a whole-person care approach to needed services.

Community Cafe

Located within walking distance of the Sacramento County Main Jail, our Community Cafe is a welcoming and safe place for individuals transitioning from incarceration to connect with health coverage, health services, housing support, and other health and social resources.

Hospitals

We are partnered with major hospital systems in Sacramento county to support patients with post hospital/emergency department care by connecting them to a medical home for all their health needs.

Our partnering hospitals are:

Mercy General Hospital
Methodist Hospital
Mercy San Juan Hospital
Mercy Folsom Hospital
Sutter General Hospital
UC Davis Hospital
Kaiser Permanente South Sacramento

Access to Food

We're committed to providing access to food and nutritious meals to those who need it most.

Since 2017, we have enrolled more than 1,000 individuals into CalFresh and provided nearly 600 referrals to local food programs and services.

In the first 10 weeks of the COVID-19 pandemic in 2020, we delivered more than 21,000 fresh meals to individuals who were medically vulnerable - both newly housed and experiencing homelessness.

Transportation

We know that, for many people, getting to and from medical appointments is incredibly important. Every second of the day matters, and we make sure our clients don't end up missing appointments that can help them get the care they need.

In 2021, we scheduled more than 4,000 transportation services to help get clients to their medical, housing and other health-related appointments.