Co-Locating Care Management Staff and Peers in Medical Clinics: Advancing the HIV Continuum of Care

Presenters will describe a medical community collaboration to resolve care gaps and improve patient health outcomes through the co-location of health home care management by a community-based organization (CBO) within medical clinics. Panel members will share successes and challenges of implementation of the project and integrating a CBO care team into a medical clinic.

Learning Objectives

1. Demonstrate effectiveness of medical providers and CBOs leveraging health home care management and peer navigation to deliver an integrated model of care that improves health outcomes and reduces Medicaid spending among patients with chronic conditions who are not able to successfully manage their conditions through traditional, clinic-based services alone.
2. Identify strategies to utilize peer navigators and community health workers as a 'bridge to care' through motivational interviewing and care navigation.
3. Describe necessary steps to successfully integrate a CBO care team into a medical clinic.