HomeAdvantage® is a 60-day case management program providing tailored services through in-home and telephonic support to Snohomish County adults who have one or more chronic illness. Benefits include personalized support and a range of services offered directly by Homage. Results include increased confidence in navigating the healthcare system, greater awareness of and access to community resources. HomeAdvantage® closes the gap between social and medical issues impacting health and quality of life through proactive care management.
Homage has been providing vital non-medical services directly impacting Social Determinants of Health (SDoH) in the community for over 45 years. Having a suite of services under one roof uniquely positions Homage to provide comprehensive support. HomeAdvantage® Care Coordinators are the established link to helping people age well in place.
A HomeAdvantage® Intake Specialist receives referral from the hospital or clinic, and connects Care Coordinator with the client to schedule their first visit, either in the hospital or at home. This visit will include an initial SDoH evaluation and preliminary care plan development tailored to the their specific needs.
Care Coordinators assist clients to review and better understand their Patient Health Record (PHR) to identify ‘red flags’, ensure follow up appointments and transportation are scheduled, review medication adherence and coordinate resources to encourage their recovery. Resources provided directly by Homage include in home care coordination, transportation, meal delivery, and fall prevention education.
Prior to program graduation, our clients will be provided with post-transition resource information as part of a Follow-up Care Plan. A satisfaction survey and post-service SDoH evaluation will be conducted after program is completed.
- Enrollment in Medicare Advantage Plan in Snohomish County
- Has one or more chronic conditions including: CHF, COPD, Diabetes, Asthma, Chronic Kidney Disease, Cancer, Parkinson’s, MS, Autoimmune Disorders
- Hospital admission or high risk for admission referred by physician.
- Services Offered:
- In-home Care Coordination
- Medical Related Transportation
- Home Delivered Meals
- Fall Prevention Education
- Outcomes Expected:
- Reduced SDoH risk score
- Reduced risk of readmission
- Reduced risk of ED visits
- Improved awareness of available medical and non-medical resources
- Increased Healthcare IQ / health literacy
- Increased well days
- Decreased length of stay
- Improved client experience