Community Health Center Network and Welkin Health Partner to Improve Health Outcomes for Bay Area's Most At-Risk Populations

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Health 2.0, with the support of the Robert Wood Johnson Foundation, to award grant to develop complex case management platform for underserved populations

Community Health Center Network (CHCN), a non-profit public benefit corporation, and Welkin Health, a San Francisco-based digital health company specializing in patient relationship management, have partnered to develop a complex case management platform to elevate the success of CHCN’s Care Neighborhood program. The innovative program addresses and supports the health needs of the East Bay’s most at-risk and underserved populations through consistent patient outreach by Community Health Workers (CHWs) embedded in the CHCN health centers.

Selected as one of three national finalists for Health 2.0’s Technology for Healthy Communities initiative, a project supported by the Robert Wood Johnson Foundation, Welkin Health will develop a complex case management platform for CHCN. Emphasizing strong patient coaching and data-driven insights, the platform will help CHCN health centers streamline communication efforts between patients and CHWs, increasing engagement, reducing costs and leading to improved long-term health outcomes for patients. It will also aggregate patient data from EHR systems and claims databases to provide CHWs with optimal clinical decision support, increasing efficiency and the ability to track health improvements of enrolled patients over time.

The platform will launch at three CHCN health centers in the Alameda County with a goal to eventually expand to support Care Neighborhood programs at all eight health centers that are members of the network.

CHCN and Welkin Health were partnered through Health 2.0’s Technology for Healthy Communities—a program which connects underserved communities with digital health innovators to develop projects aimed at improving health outcomes for vulnerable populations.

“The effectiveness of our Care Neighborhood program is rooted in our ability to successfully connect and follow up with patients,” says Rajib Ghosh, Chief Data and Transformation Officer, CHCN. Up to this point, the program’s CHWs have relied on phone calls and in-person visits, all inputted and tracked via a preliminary prototype system, to engage patients.

“Welkin understood the need to integrate all of our data – claims, EHR, community data and patient communications – into a platform that drives Community Health Worker workflow seamlessly,” said Kristian Lau, Manager of Strategic Initiatives at CHCN and the Program Manager for the Care Neighborhood program. “We are excited to partner with Welkin to create a platform that helps Community Health Workers do what they do best: build great relationships.”

Welkin’s platform is configurable, allowing the team to design the technology to meet the specific needs of the Care Neighborhood program which include a personalized workflow for each clinic’s CHWs and integrations with the clinic EHRs and CHCN’s claims database.

Providing more channels of communication such as by text messaging, email, and phone, will help better identify the patients most at-risk and allow for timely intervention. Additionally, CHWs will be able to utilize Welkin’s platform to remotely monitor patients with ongoing health issues, such as chronic diseases, increasing the likelihood that patients adhere to medication, diet and exercise plans.

“CHCN serves patients whose needs are complex. These individuals are among those facing the most risk due to social determinants beyond their control,” says Chase Hensel, co-founder and CEO, Welkin Health. “Our platform will create more pathways of communication between CHWs and patients, help to streamline workflow and provide the ability to capture critical data about this population in the hopes of improving the health outcomes in these communities for the long-term.”

About Welkin Health
Welkin Health is a digital health company that helps healthcare organizations increase revenue and reduce operational costs with improved health outcomes through engagement, education, and support programs for people living with chronic disease. Our workflow and communication software, customized for each partner, allows care teams to prioritize patient outreach and reach clients on any device, including SMS, phone call, and email. Welkin helps teams focus on building and maintaining long-term relationships with custom configurations of the Welkin patient relationship management platform. To inquire about partnering with Welkin, write to partnerships(at)welkinhealth(dot)com.

About Community Health Center Network
CHCN is a non-profit Medi-Cal managed care organization, providing business administrative support for eight member community health centers to focus on what matters most – patients. CHCN and its member health centers are headquartered in the Alameda County, California with services provided to 80+ locations across the East Bay. CHCN was formed in 1996 and it is committed to excellent, affordable care for underserved communities.

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Ashley Greer
Welkin Health
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