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At Unite Us, we often speak about the "patient journey." It is something that drives our innovation and something we know is critical to making and proving an impact. As organizations along the continuum increase coordination, it becomes important to be able to track EVERYTHING. With Unite Us, you and your partners are able to gain visibility into your patients' health journeys before and after they come through your walls. Take a look at the patient journey of one individual that was connected to services through NCServes Western, a coordinated network that is part of the AmericaServes initiative led by the Institute for Veterans and Military Families (IVMF) out of Syracuse University.
Below is the journey of one client, a Marine Veteran in North Carolina, that was connected to NCServes Western last August. Over the course of eight months, the client received care from 8 different providers in the community to address 10 different service needs. Today, NCServes Western is proud to say that, together as a network of providers, they were able to deliver holistic care to this client and now have the data and outcomes to prove it.
With Unite Us, communities and organizations are equipped with invaluable data and information captured during every stage of service delivery from screenings, referrals, assessments, to individual outcomes.
Hover over each box to see each step in the client’s journey
AUGUST 1 Housing Referral Created
On August 1st, the client in need showed up at the Charles George VAMC in Asheville, NC. In that visit, it was discovered that the client was in need of financial assistance to move into a new house. The initial ask led Charles George VAMC to send a referral to the Marine Corps League, the eligible provider for this referral.
AUGUST 7 Housing Assistance Received
On August 7th, the Marine Corps League assisted the client with paying storage arrears and helped move his belonging to a new residence. In just 6 days the client received the appropriate services to secure stable housing.
AUGUST 8 Social Enrichment Received
In the process of receiving assistance, the client felt a part of a new tribe within the Marine Corps League. This organically led to a social enrichment benefit, due to a paid membership with the Marine Corps League. This new found support team increases the client’s confidence and trust in the community.
AUGUST 11 Employment Referral Created
On August 11th an additional referral for the same client was made to Goodwill Industries to support him with finding a job. Immediately Goodwill Industries helped him work on his resume and job search.
AUGUST 14 Transportation Referral Created
On August 14th the Marine Corps League discovered that their client was in need of transportation assistance and created a referral to NC Brookhaven. Additionally, the client stated that a bike would be helpful and picked up a bike the same day!
SEPTEMBER 12 Benefits Referral Created
On September 12th a new referral was created for the client for a VA disability claim. The Referral was sent to Buncombe County Veteran’s Service Office.
SEPTEMBER 26Employment Secured
On September 26th, through the employment referral made to Goodwill Industries, the client secured employment at Hilton Hotel in their maintenance department.
NOVEMBER 21 Food Assistance Received
On November 21st Asheville Buncombe Community Christian Ministry provided the client with food for a Thanksgiving meal. Since the client is part of the network he has access to additional services in the community.
NOVEMBER 30 Transportation Referral Created and Resolved
On November 3oth, the client needed transportation to Hampton, VA in order to attend his sisters funeral. An out of network provider supported the bus ticket to get him there. The client received immediate support in the same day.
JANUARY 25 Transportation Assistance Received
On January 25th, NC Brookhaven provided a one-year bus pass to their client to accommodate more reliable transportation to ensure he is able to get to his job and additional appointments in the community.
MARCH 6Client Enrolled in Health Class
On March 6th the client enrolled in Vaya Health’s peer support training class, which enables individuals in recovery to support others in their recovery journey.
MARCH 8Social Enrichment
On March 8th the client was highlighted and honored at NCServes Western’s 6-month internal progress review (IPR) and received a shadowbox with his military medals earned in service, presented from several community providers and the coordination team.