Page 36 - Total Care Guide 2018_BRD-TCG-518
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Community Mental Health Services



        Health Home Care Management


        VNSNY’s Health Home is a care management and service
        care coordination program for Medicaid recipients with
        behavioral health and/or substance use problems, HIV/AIDS
        and/or multiple chronic illnesses for patients in the Bronx,
        Brooklyn and Manhattan.
        For these medically and psychosocially complex patients,
        VNSNY care managers provide access to and coordinate
        all of the health and support services an individual needs
        to remain safely and independently at home, and avoid
        institutional care.  These dedicated care managers:
        •   Work in the community to continually assess the lifestyle
          and health of their patients to create a plan of care that
          meets all physical, mental, chemical dependency and
          social service needs
        •   Work with partnership companies to arrange and manage
          services including medical care, dental care, behavioral
          health, housing, substance abuse services, legal services
          and family support
        •   Educate patient/families about disease and teach
          self-care strategies
        •   Collaborate with hospitals to help the patient safely
          return to the community following a hospitalization
        •   Help ensure adherence to medications as well as secure
          and help the patient keep medical appointments

        For more information, call 212-609-4105.
        Service Area:  Bronx, Brooklyn and Manhattan
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