Enhanced Care Coordination

Eliot’s BH CP Program uses a team approach designed to enhance care coordination and integration of behavioral and physical health services for individuals with complex, co-occurring diagnoses, and improve outcomes.

Integrated and goal-focused

improved health and wellness

BH CP provides services to support clients reach self-determined goals for improved health and overall wellness. Our Team of Care Coordinators, Nurses, and Clinicians are friendly, highly skilled, and ready to work with you in ways that meet your needs.

Services Include:

  • Outreach and active community engagement

  • Identification, engagement, and facilitation of member’s care team, including primary care physicians, behavioral health providers, and other providers on an ongoing basis

  • Comprehensive assessment and person-centered treatment planning across behavioral health, long term service supports, physical health, and social factors

  • Service coordination across the continuum of care

  • Support for transitions of care between settings

  • Comprehensive health and wellness coaching

  • Access, referrals and systems navigation for social services

One in five adults experience mental illness each year and one in twenty experience serious mental illness. Eliot’s BH CP Program shows that targeting resources, fully integrating teams, developing care plans that encourage patient buy-in, and attending to outcomes are all the building blocks of improved health and overall wellness. Specifically, a recent analysis found that individuals engaged in Eliot’s BH CP had:

  • Improved access to Outpatient Behavioral Health Care;
  • Improved medication adherence;
  • Improved behavioral health follow care after a psychiatric hospital discharge;
  • Improved access to preventive physical health care; and
  • Reduced psychiatric admissions and readmissions.

Learn more.