Illinois Pathways to Health – Community Care Hub

Illinois Pathways to Health is at the forefront of the Community Care Hub movement—a national model supported by the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the Administration for Community Living (ACL). These hubs combine healthcare with social support services to ensure better overall health outcomes.

As a statewide hub, we offer a structured care system that streamlines referrals and ensures ongoing support for partners, clients, and healthcare organizations across Illinois.

Our Community Care Hub Capabilities

We specialize in the infrastructure and support services needed to connect individuals and communities to the programs that improve their health and well-being. This includes:

🔷 Invoicing & Payments – Processing and tracking payments.

🔷 Contracting & Network Management – Managing contract negotiations and legal support.

🔷 Marketing & Outreach – Equipping partners with program and marketing materials.

🔷 Recruitment – Expanding our reach by recruiting new participants.

🔷 Workforce Training – Offering training to maintain service quality and program fidelity.

🔷 Referral & Enrollment – Screening for eligible clients and securing referrals.

🔷 Data Reporting & Analysis – Collecting and submitting data to track program effectiveness and compliance.

🔷 Partner Engagement & Support – Providing data systems and support to help partners manage their workshops.

🔷 HIPAA Compliance Training – Protecting participant privacy and security.

What Sets Us Apart

Through innovation, collaboration, and expertise, we are transforming how communities access and receive care:

🔷 Our Mission – We innovate, partner, and advocate to improve systems and services in order to strengthen communities so people thrive as they age.

🔷 Part of the National Community Care Hub Movement – Selected for the National Learning Collaborative (led by CMS, ACL, and the CDC) to integrate healthcare and social services. 

🔷 Strong Infrastructure – Funded by USAging, ensuring continued network growth.

🔷 Social Care Experts – We blend and braid resources to address health-related social needs (HRSNs), providing comprehensive solutions to overcome barriers to health.

🔷 Leaders in Innovation – A partner of the Health Equity Learning Collaborative - Partnership to Align Social Change, working to improve health equity for Illinois residents.

🔷 Statewide Partnerships – We collaborate with health systems, community-based organizations, and public health entities to expand impact.

🔷 Sustainability-Focused – Our expert grant-writing team secures funding to support long-term program success, with future plans to implement Medicare & Medicaid billing.

Our Impact

Since 2015, Illinois Pathways to Health (ILPTH) has positively impacted the lives of over 13,000 Illinois residents through evidence-based health promotion programs. 

Our Trained Leaders & Certifications:

• 308 trained leaders delivering high-quality, evidence-based programs
• 665 total certifications across multiple programs, ensuring expert facilitation and participant success

Key Achievements in FY24:

• 170+ workshops hosted in 22 counties across Illinois
• 1,735 participants, with 1,121 completing the full series
• 79% of participants reported excellent or good health after completing a Self-Management workshop
• 91% of participants expressed satisfaction with the Self-Management program, and 96% with the Falls Prevention program
• 80.4 Net Promoter Score, with 80% of participants recommending the Self-Management program.

Program Outcomes:

• Self-Management Program: 82% of participants reported increased confidence in managing chronic conditions after completing the program (up from 78% pre-program).
• Falls Prevention: 94% of participants felt more comfortable increasing their activity post-program, and 81% reported a reduced fear of falling.
• Health Improvement: Participants in the Self-Management program saw an 8.85% improvement in their self-reported health.
• Falls Prevention Results: Participants in the Falls Prevention workshops, such as A Matter of Balance, saw a 6.4% reduction in the rate of falls.

Cultural Reach:

We ensure our programs are accessible to diverse communities. Workshops are available in Spanish, Arabic, Chinese, Hindi, and Korean, broadening our impact and providing essential support to individuals from various cultural backgrounds.

Our programs not only help participants feel more confident in managing their health but also enhance self-care, improve communication with healthcare providers, and create stronger connections within their communities.

📄 Read our 2024 Year in Review (PDF)

Interested in Joining Our Network?

If you're a healthcare plan, community organization, or interested partner, we welcome you to collaborate with us. Whether you're looking to add an evidence-based program or product to our Community Care Hub, or want to help expand our collective impact, contact us to explore partnership opportunities.

Contact:
Rob Mapes
VP of Health Collaborations & Innovations

✉️ Email: robert.mapes@ageoptions.org