The Need

As residents lose coverage, access to primary care for chronic disease management will decrease, leading to complications and emergency department utilization.

The Solution

Establish evidence-based prevention and management programs throughout all 17 communities, specifically aimed at serving residents who lose coverage.

What This Could Look Like

• Diabetes prevention classes using CDC-recognized curricula at places where seniors regularly gather and congregate
• Home blood pressure monitoring kits with nurse-led medication management support
• Chronic disease self-management education teaching independent management skills
• Peer support groups connecting residents managing similar conditions

Why This Works

Meets people in their communities, addresses documented need, uses proven evidence-based programs, and prevents complications.