Our impact on people

Patient snapshot:

  • Male in his 70s
  • Mobility issues, no support system, complained of constipation issues
  • Used emergency room 30 times in less than one year as a safe space to prevent loneliness and anxiety

Personalized, whole-person care builds trust and enhances outcomes

The patient's care manager contacted his PCP about the patient's constipation and frequent ER visits. After the care team spoke with the patient further, they discovered he felt very lonely and had anxiety. His frequent visits to the ER were due to a lack of human interaction. He did not think he could afford a senior living facility, but the care team worked with him to review his financials and find the best place for him to live. The care team provided personalized, culturally competent care that addressed both his medical and social well-being.

Now residing in a senior living facility, the patient is thriving. The care team took the time to build trust, uncover his real issues and needs, and provide support throughout the patient journey. As a result, this patient participates in activities, has gained weight, improved his mobility, and enjoys regular visits from family.

Source: Medical Home Network REACH ACO

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Results that matter

Today MHN works with federally qualified health centers in seven states to help them build the right capabilities to be successful under value-based care in both Medicaid and Medicare. 

Our work began in Chicago where we organized the first Medicaid ACO and dramatically improved the health of more than 180,000 Chicago safety-net patients.

11% Lower Emergency Department Utilization

36% Lower In-Patient Days

89% of patients engaged in
completing their Health Risk Assessments

Collaborating to connect the healthcare ecosystem

We connected providers to support one of the largest Medicaid health plans in Chicago.

23 Hospitals
+300 Primary Care Entities
180,000 Safety Net Patients