Community Care
CFD provides community-based services in partnership with Northwest Medical Homes (NWMH) and Trillium Community Health Plans.
The Integrated Community Care Management (ICCM) program has a multidisciplinary team consisting of a Nurse Care Manager, Case Manager, Community Health Worker, Medical Assistant, and Therapist.
The team assists patients with complex medical and mental health conditions. Some of the areas the team can help with are housing resources, food shortage needs, assistance with navigating the medical system, attending medical appointments, and coordinating care between medical providers.
The Coordinated Community Care program utilizes case management staff to support the medical outreach of NWMH.
We work with dual-eligible special needs populations (DSNP) who are covered by Medicare and Medicaid to ensure that their medical and behavioral health needs are being met.
At this time, patients who qualify for these programs have been contacted and referrals are not accepted from the community.