What We Do

Care Coordination

Managing holistic care across home, community, and other settings

Asthma

Diabetes

Cardiovascular Disease

Mental Health

COPD

Better Life Learning coordinates

Better Life Learning coordinates and delivers clinical, social, and behavioral health services during every point of the patient journey. From helping post-discharge patients safely transition to the next site of care, to supporting their whole-health needs once they’ve arrived at home, we enable services to be delivered quickly, reliably, and in coordination with all interventions.

Better Life Learning leverages our vast network of nurses, social workers, community health workers, and community-based services to help clients. Used as a standalone offering, or to amplify your existing episodes-of-care program, we enable communication and collaboration across all members participating in a client’s healthcare.

Smooth and informed intake and discharge

Ensures the intake and discharge process is smooth and the client is compliant with instructions.

Complete plan of care

Coordinates and secures a complete plan of care that includes clinical, social, and behavioral health interventions.

Non-medical health needs

Uncovers and addresses social determinants of health that can increase readmission risk.

Social Care Coordination

Social determinants of health (SDOH) put outcomes at risk—and they can’t be solved with a simple referral. At Better Life, our integrated SDOH solution breaks down the traditional barriers between clinical and community care, allowing healthcare and social service agencies to work collaboratively within a privacy-enabled model. Finally, you can connect upstream social interventions to patient outcomes and plan performance goals.

Segmentation & risk scores

Identifies social risk with predictive SDOH analytics, HRE data, and assessments.

Coordinated social care networks

Combines our nationwide network of community- and faith-based organizations with a specialized team of social care coordinators.

Privacy-enabled collaboration

Facilitates the safe and compliant exchange of information across mission-driven organizations and the healthcare ecosystem.

Longitudinal records

Documents clinical and social information on real-time longitudinal records for a complete picture of each person’s health status.

Proven outcomes

Better Life Learning’s privacy-enabled framework connect upstream social interventions to patient outcomes and plan performance goals.

Complex Care Management

We comprehensively manage the clinical and social needs of clients with chronic (Asthma, COPD, Diabetes, Cardiovascular Disease, and Mental Health) conditions—replacing fragmented care with a multi-disciplinary approach. We provide care wherever it’s most convenient for patients and their families: from telephone, virtual, and in their homes.

Patient segmentation

Identifies and stratifies members by risk

Personalized care

Enables providers to sit face-to-face with member for an enhanced experience

Education as prevention

Focuses on follow-up behavior and education as preventative care

Non-medical health needs

Uncovers social determinants of health such as spousal support or food insecurity

Medication review

Works with clients to review medications and increase adherence

How We Provide Service

  • In-home Case Management
  • Telephonic Case Management
  • Virtual – Telehealth Case Management
  • Remote Patient Monitoring
  • Community Health Education and Training

News & Insights

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