The WellBe care model is a Physician Led Advanced Geriatric Care Program focused on the quality of care of the frail, poly-chronic, and elderly Medicare Advantage patients. This population is typically underserved and very challenged with access to overall health care. To address these problems, we have elected to bring the care to the patient, instead of trying to bring the patient to the care. WellBe’s Care Model is to provide our members the entire continuum of care from chronic to urgent care in the home, hospital, skilled nursing facility, assisted living, palliative care, and to end of life care. WellBe's physician/advanced practicing clinician led geriatric care teams’ partner with the patient’s primary care physician to provide concierge level geriatric medical care and social support in the home as well as delivering and coordinating across the entire care continuum.
The Community Health Navigator (CHN) is responsible for helping patients, families, and community teams to navigate and access services and resources in each community served. The CHN supports the social workers and community teams through an integrated approach to care management and community outreach. CHN’s will prioritize activities to promote and improve the health of patients and their families.