We serve many of the most medically needy folks in the homeless and behavioral health systems. Many of our participants come to Pathways with serious, chronic, untreated medical problems. Their many issues require a lot of health care coordination.
To address the level of medical need, Pathways PA formed an Integrated Health Care Program. Pathways currently benefits from a partnership with Thomas Jefferson University/Department of Family and Community Medicine. Dr. Lara Weinstein, from their staff, has been treating clients at Pathways PA for several years and has reported on the magnitude of the physical health care needs of this population, as well as on the remarkable progress she’s seen by the limited access to direct care that she has been able to provide. Dr. Weinstein works with the five nurse/service coordinators on the service teams. Together, they provide comprehensive primary care to clients who haven't connected or won't connect with traditional healthcare services. Services include ongoing primary care, acute care, chronic disease management, coordination of hospital to home transitions, and preventive care. Services are provided onsite at Pathways PA, in clients’ homes, during hospital visits, and at Jefferson Family Medicine Associates outpatient clinics.
The coordination of medical and behavioral healthcare with onsite staff psychiatrists and the development of a system of population based health and wellness management is also part of the team’s responsibilities. The team provides support of individual and group health and wellness programs in coordination with clients and staff. Their services include health education, health screenings, chronic disease self-management support, and illness-prevention /immunization programs.
Recently, this partnership has included Project H.O.M.E. who has been funded to open a Federally Qualified Health Center (FQHC) in North Philly. Part of Pathways' integrated healthcare services will now be provided through a partnership with the FQHC. You can read more about that HERE.
We believe that housing is a medical intervention, and we are making a huge impact on quality, access and cost in the health care arena.
We need your help to continue offering real solutions to chronic homelessness in Philadelphia.