Care Coordination
The Care Continuum Network
Achieving whole-person health means taking into account both medical conditions and the social determinants of health. This framework is the foundation of our Care Continuum Network (CCN). The CCN is an ever-expanding network of services designed to bring disparate programs together to support health—from preconception to end of life—while reducing silos and barriers.
Health Homes
Long-Term Wraparound Care for High-Risk Individuals
In partnership with the Washington State Health Care Authority, Health Homes helps seriously ill individuals of all ages navigate the larger ecosystem of care, reach health goals and improve their self-management skills.
Community Health Action Teams
Rapid Response and Intensive Short-Term Care for Medium- to High-Risk Individuals
Patient-centered and multidisciplinary teams integrate physical and mental health expertise to provide fast, direct and personalized support and counsel to people—especially those experiencing homeslessness or substance use disorder—who need help understanding and accessing different types of medical and social services.
Pathways Community HUB
Focused, Learning-Based Care Coordination Services for Low- and Medium-Risk Individuals
Leveraging more than 20 years of evidence, the Pathways Community HUB trains community health workers to help people navigate health and social services systems. Together, the pair select and follow customizable plans of action, called Pathways, to eliminate barriers in reaching positive health outcomes.
The Care Continuum Network in Action
Read more stories about how the Care Continuum Network serves our community.
Advance Accessible, Coordinated, Whole-Person Care
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Become a Health Ally
Join UsHelp advance positive change in our community as a Health Homes Care Coordinator or Pathways Community Health Worker.
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Partner With Us
Become a PartnerWe want to collaborate with your organization to support people in need, close gaps in services, and affect positive change in our community.
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Support Our Work
Learn MoreBuild a better future for all Pierce County residents by contributing to the OnePierce Community Resiliency Fund.