Addressing Everyday Needs That Impact Health
Helping people access the services that strengthen stability and well-being.
Health is shaped by more than medical care alone. Our Care Management and Social Care Network services work together to connect people to the right supports — improving health, strengthening stability, and helping people remain active in their communities.
- Coordination of safe housing
- Networks provide access to food
- Help securing reliable transportation
Care Management for adults and children helps organize and coordinate services when multiple providers and systems are involved. Our Care Managers work alongside individuals, families, healthcare providers, and community partners to create clear care plans, reduce gaps in services, and support follow-through.
Services may include care planning, referrals, appointment coordination, benefits navigation, and ongoing communication between providers. The goal is coordinated, person-centered support that makes healthcare easier to manage and more responsive to each person’s needs.
Health is affected by more than doctor visits. Things like safe housing, enough food, and reliable transportation can make a big difference.
Through New York State’s Social Care Network under the 1115 waiver, and in partnership with the Hudson Valley Care Coalition, we help identify these needs and connect eligible individuals to community services. Our team completes a brief screening to understand what support may be helpful. When a need is identified, we make referrals to trusted local providers and help coordinate next steps.
By linking healthcare and community resources, we help remove everyday barriers that can affect health and well-being.