The Denver Regional Council of Government's Area Agency on Aging Community Care Hub was established in 2022 to streamline and coordinate access to a regional network of local community-based organizations. The hub facilitates access to community-based organizations' services to address the health-related social needs of people referred by contracted partners. The hub's goal is to improve the health outcomes of residents by connecting them with their chosen community-based organizations to help meet their needs.
The hub serves as a bridge between healthcare providers and community-based organizations by managing referrals, administrative functions, data collection and reporting, and other functions to streamline service delivery.
The hub’s primary goal is to address the health-related social needs of people referred to us from clinical partners. The needs include housing, food security and nutrition, transportation and many others that can impact health outcomes.
To deliver health-related social needs services, the hub contracts with numerous local community-based organizations to provide a comprehensive range of services to clients of all ages. After a person receives a referral to the hub and agrees to receive services, a community resource navigator will contact a client and provide the following services:
- Guide clients through a personalized needs assessment to gain a complete understanding of their needs.
- Develop a person-centered action plan to address clients’ needs.
- Receive permission from the client use technology to send the client's information to the network of community-based organizations selected by the client.
- Report enrollment and service delivery information to the community care hub after receiving the client's permission.
- Send the client’s enrollment and service delivery information to the client’s healthcare provider after receiving the client's approval.
To learn more about the services offered via the Community Care Hub, contact integrated health manager AJ Diamontopoulos or 303-480-6767.