Investment in care management drives meaningful health outcomes. It not only de-silos the healthcare ecosystem but drives undeniable improvements in health equity and whole-person care. Foothold Care Management software makes it possible for every person to have a single, comprehensive care plan that informs and is informed by their needs and experiences. We position SCNs to exceed the 1115 Waiver goal of delivering higher-quality, whole-person care in New York.
Foothold brings a legacy of over 20 years in nuanced care coordination and are now channeling that depth of experience into empowering SCNs. Our platform is fine-tuned to meet the unique requirements of the NY 1115 Waiver, making us the natural choice for Social Care Networks seeking to deliver top-tier, evidence-based social care to New Yorkers.
To drive proven outcomes, SCNs must ensure all aspects of a person’s health—physical and social determinants—are considered and managed. Whole-person care is the patient-centered optimal use of diverse healthcare resources to deliver the physical, behavioral, emotional, and social services required to improve care coordination, well-being, and health outcomes while respecting patients’ treatment choices.
SCNs have a significant opportunity to enhance the capacity of grassroots Community-Based Organizations (CBOs) that are pivotal in delivering essential services to local communities. While these organizations are deeply familiar with the diverse needs of their communities, they often encounter obstacles that hinder effective service delivery. Strategic investments in care management can empower CBOs to overcome these barriers, enabling them to provide holistic care directly to the communities they serve.
The New York State 1115 Waiver marks a significant advancement in healthcare, introducing SCNs to enhance community health across New York. SCNs are set to transform the healthcare landscape by integrating essential non-medical services—such as housing support, reliable transportation, and nutrition —into overall health strategies. This holistic approach not only addresses immediate health-related social needs (HRSN) but also ensures long-term health maintenance and prevention of chronic conditions, effectively reducing the need for hospital visits and complex treatments.
Foothold’s Care Management tool (FCM) is pivotal in enabling SCNs to implement this integrated care model. By facilitating robust collaboration with Community-Based Organizations, FCM streamlines the delivery of comprehensive services, ensuring that members with multiple needs have a comprehensive care plan that is waiver compliant and precisely tailored. This empowers Social Care Navigators and providers to significantly enhance the quality of life for New Yorkers beyond traditional clinical settings.
Imagine the impact if a person in need at a food pantry within an SCN ecosystem could be immediately connected to a care manager, revealing and addressing a spectrum of needs. This is the transformative potential of SCNs enabled by Foothold, the true ability to drive positive health outcomes in care.
Tailor each care plan to meet and adapt to individual health conditions, life circumstances, and needs of every person served. FCM can organize care plans and ensure that interventions are precisely aligned with client’s goals and well-being, so you can focus on their care.
Our system offers continuous monitoring and in-depth analysis of care plan, ensuring every client receives the attention they deserve. With real-time alerts and actionable insights, you can quickly identify and address any gaps in service, optimizing care outcomes and enhancing operational efficiency.
Foothold’s DataStudio transcends traditional closed-loop referral metrics to assess health improvements across the community. It provides deep insights into population health trends, enabling SCNs to make informed strategic decisions centered on member health outcomes. This approach not only tracks but actively improves health care delivery, placing member well-being at the forefront of every decision.
Designed by and for care managers, our FCM platform streamlines member documentation and enhances field efficiency. Care managers can easily document activities, track member progress through intuitive dashboards, and spend less time on administrative tasks.
“I’ve heard consistently — from every Care Manager I’ve spoken with — that Foothold Care Management’s system is the one they want to be using. When we talk to CMAs considering joining CCMP, Foothold Care Management is a major selling point.”
Nathan Ito-Prine
CEO, Community Care Management Partners Health Home
Investment into care management is critical to the success of Social Care Networks and compliance with the 1115 Waiver goal to achieve meaningful, whole-person health outcomes.
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