Naturally Occurring Care Network (NOCN) Initiatives
In 2019, FLPPS NOCNs developed solutions and identified interventions to address key underperforming clinical outcomes specific to each NOCN region after performing a root cause analysis.
| Partner | Project Description |
|---|---|
| Family Services of Chemung County, Inc | Promote Health Home services with marketing material for potential recipients and referral agencies, along with coordination of a Care Management Agency (CMA) Collaborative. |
| Finger Lakes Community Health (Finger Lakes Health) | Dental case manager collaborations with local Emergency Departments. |
| Finger Lakes Area Counseling and Recovery Agency | Embed a Substance Use Disorder (SUD) counselor in an Emergency Department. |
| Finger Lakes Area Counseling and Recovery Agency | Formation of an Emergency Medical Service Diversion Workgroup for collaboration with local law enforcement. |
| Finger Lakes Area Counseling and Recovery Agency (Seneca County) | Detox follow-up after discharge from inpatient admission. |
| Lake Plains Community Care Network | Regional community navigation coordination to assess, train, and support existing navigation services. |
| McKinley & Carey Collaborative | Homeless outreach and peer support program to hire engagement specialists and provide training to clinical practices servicing the homeless population while linking homeless patients to Health Home, Mental Health and/or Substance Use Disorder (SUD) services. |
| Recovery Coach University | Peer Recovery Coach training for 30 peers and coordination of assignment to specific service providers to acquire hours to qualify for certification. |
| S2AY Rural Health Network | Community navigation for high-utilizers and training for hospital staff on best practice Community-Based Organization (CBO) referral process enhancement. |
| S2AY Rural Health Network (Ardent Solution) | Training and outreach to Primary Care and hospital providers to increase linkages to community-based services. |
