Care Continuum Network

Our Care Continuum Network connects vulnerable and under-served populations to services and resources for whole-person health and community advocacy. We convene organizations from the community to identify and prioritize community health needs. By collaborating to share strengths and address challenges, we eliminate duplication and remove barriers across the spectrum of care and services.

Empowering Coordinated,
Whole-Person Care

 

We convene community-based and clinical organizations to provide healthcare and wraparound services to improve the livelihood of those in need. By addressing social determinants of health and supporting patient navigation of health systems, we empower individuals facing complex health needs with tools and resources for improved quality of life.

Community Health Action Teams

Community Health Action Teams

People living with complex medical and mental health conditions often struggle to address their basic needs. As a result, they often revolve in and out of emergency rooms. Community Health Action Teams (CHATs) may consist of a provider, a nurse case manager, a mental health practitioner or social worker, and a community health worker. This team works together to provide wrap-around services to reduce issues and access to care.

Pathways HUB

Pathways HUB

The Pathways Community HUB model provides community-based and person-centered care coordination for vulnerable and traditionally under-served populations. This approach identifies specific social and health needs—called pathways—and supports clients with prioritizing and addressing their needs. There are 20 pathways to healthy living, such as health education, family planning, health insurance, housing, immunizations, and social service referral.

Health Homes

Health Homes

Elevate Health is designated by the Washington State Health Care Authority as a Health Homes lead organization. We partner with community and clinical organizations who provide care coordination services to individuals with complex health needs. We are providing training and oversight to support the Health Homes program.

Community Health Action Teams

People living with complex medical and mental health conditions often struggle to address their basic needs. As a result, they often revolve in and out of emergency rooms. Community Health Action Teams (CHATs) consist of a provider, a nurse case manager, a mental health practitioner or social worker, and a community health worker. This team works together to break down silos and increase communication to connect clients to tools and resources for improving quality of life.

Pathways HUB

The Pathways Community HUB model provides community-based and person-centered care coordination for vulnerable and traditionally under-served populations. This approach identifies specific social and health needs—called pathways—and supports clients with prioritizing and addressing their needs. There are 20 pathways to healthy living, including adult education, family planning, health insurance, housing, immunizations, and social service referral.

Health Homes

Through Health Homes, we help our most at-risk Pierce County residents connect to long-term, supportive care management. Elevate Health has been designated by the Washington State Health Care Authority to lead care coordination organizations in the region, providing training and oversight to promote high quality, holistic care.

FEATURED STORY

How Pathways Community HUB is changing lives in Pierce County.

For a single mother expecting her second child, knowing how to best prepare for all the changes that come along with a new baby isn’t easy. And that’s exactly the position Tara found herself in earlier this year.

Thankfully, she found help from a new friend named Ash.

Ash Martinez’s work with HopeSparks, a Pierce County area behavioral health care and family services provider, includes her role as a community care coordinator for Pierce County ACH’s Pathways Community HUB. She was able to meet with Tara twice a month to help her through her pregnancy and actively maneuver through obstacles that could get in the way of Tara creating a healthy life for both herself and her new baby girl.

 

Read the full story here