Pathways Community HUB (Pathways) is a care coordination model developed by Drs. Sarah and Mark Redding at the Pathways Community HUB Institute (PCHI) in Ohio. It is based on more than 20 years of evidence gathered through collaboration with community health workers (CHWs).
Learning-Based Coordinated Care for Low and Medium-Risk Clients
Adapted by Elevate Health, the Pathways Community HUB trains CHWs to help people navigate health and social service systems. Elevate Health’s Pathways program is the first and only PCHI certified program of its kind in Washington.
In addition to helping our clients eliminate barriers to health, Pathways saves clients time and resources. CHWs help clients navigate the two worlds of social services and health care simultaneously. The result is better health for individuals and communities, and a more efficient, centralized, and integrated care ecosystem.
In order to serve all residents of Pierce County equitably, we are recruiting partners throughout the county that focus on important and traditionally underserved and rural communities, especially people of color, veterans, immigrants, and women.
Meet the Team
Community Health Workers
Community health workers (CHWs) are the core of the Pathways program. They help people choose and implement plans, called pathways, to overcome barriers that limit access to health. The program includes 20 customizable pathways and multiple sub-pathways, addressing matters that include behavioral health, family planning, education, pregnancy, access to food, and domestic violence, among others.
Since barriers vary in complexity, some take longer to address. The employment pathway, for instance—assessing skills and history, creating a résumé, applying for jobs, holding bi-weekly check-ins, and other components—can take months to complete. Other pathways — such as finding a local food bank—might take only a few hours.
As a single, central source of information on both medical resources and social services, the CHW can address multiple needs in a single visit. This efficiency also benefits our organizational partners. Rather than employing multiple case managers for varying purposes, partners who employ CHWs are able to streamline and refine their services.
Healthcare and Social Services Groups
We work with several organizations to conduct Pathways. Each employs one or more trained CHWs who provide knowledgeable, culturally competent care.
Our partners include health care providers, government agencies and community-based organizations, among others. Our partners maintain a bi-directional relationship with Elevate Health. They employ CHWs to receive referrals generated through the HUB, and make referrals generated by their respective agencies to Pathways.
As part of the Pathways initiative, we recruit partners and train CHWs. When we launched Pathways Elevate Heath provided seed funding to support workforce development with the specific intent to integrate Pathways with the care landscape. Elevate Health also facilitates Pathways’ data into the Community Data Trust, using secure, HIPAA-compliant and HITRUST processes to monitor and guide member enrollment, needs, and engagement.
If you or someone you know if suffering a life-threatening medical or behavioral health emergency, please call 9-1-1 for immediate assistance.
If you or someone you know is experiencing a non-life-threatening but urgent mental health crisis, call one of these 24/7 crisis lines:
Pierce County Crisis Line: 800-576-7764
National Suicide Prevention Lifeline: 1-800-273-8255
If you or someone you know might benefit from non-emergent care coordination services, please contact us at firstname.lastname@example.org or call (253) 331-2380.