CCS Health-developed community HUBs, community organizations, and care coordinators including community health workers, transitions coaches, promotores, and other care coordinators:Engaged clients successfully at 60-85% consent rates, nationally.Achieved closed-loop referrals for services greater than 98%.Achieved successful measured outcomes for those service referrals 70-93% of the time.Developed lasting, sustainable community-based workforces to better community health and rapidly respond to crises. Produced over $30 million in sustainable value-based payments and $1 billion in grants and awards for community organizations in 20+ states through our systems.CCS Health is seeking partners to revolutionize community health and accelerate better health outcomes. Is your community organization ready and committed? Contact us to learn how to participate and achieve sustainability with better health outcomes.Care Coordination Systems (CCS) is the leading solution in the nation for community-based care coordination and care transitions intervention solutions needed to transform community health with sustainable community organizations, care coordinators, and transitions coaches providing better health outcomes.Care Transitions Intervention (CTI) is the leading global solution for activating people in their own health while reducing healthcare costs for hospital/emergency room utilization and readmission. We are bringing CTI sustainability, new revenue, and transitions coaches to more community organizations to continue to revolutionize community health.CCS Health assists communities, hospitals, health plans, ACOs, home health, and governments to provide greater community engagement, better community health, reduce people's clinical and social risks, improve access to care for all people, and lower healthcare costs.Real-time social determinants of health information (SDoH) are gathered through community-based care coordination and care transitions using evidence-based care models. The client’s SDoH and risk reduction progress is linked to the client’s care team to coordinate care beyond the institutional walls. Trust is rapidly developed by the CCS Health-trained care coordinators and coaches. The community organizations capture the client and SDoH information and collaborate with the clients' authorized care teams through CCS Health's patented systems. Interoperability of the CCS Health Systems with your organization's system reduces duplication and provides real-time collaboration for care teams.