About Hubs

Across the healthcare and social care landscapes, there is common recognition of the importance of addressing health related social needs (HRSNs), such as food insecurity, housing instability, and lack of transportation, and the role that social inequality plays in health disparities. To better align social care delivery with healthcare delivery and payment, health plans and systems are partnering with community-based organizations (CBOs) to coordinate and deliver whole person services that address HRSN. Recent trends indicate a growing number of health plans contracting with CBOs, particularly through Community Care Hubs and the community care networks they organize. 

Fostering Cross Sector Collaboration Between a Network of CBOs and Healthcare Organizations 

The Partners at Home Community Care Hub (“CCH” or “hub”) is a community-focused entity that organizes and supports a statewide network of community-based organizations leading the nation in prototyping models of care to provide person-centered social care services in the home and community. 

Partners provide all of the administrative services so that our providers focus on member care. Administrative services to Hub members include, but are not limited to: 

• Coordination and management of network  
• Large geographic coverage 
• Oversight and review of licensing and certification, if applicable  
• Quality Assurance (Partners is NCQA-accredited) and oversight of providers 
• Single point of entry for all referrals  

The Partners at Home Community Care Hub covers California with a full range of impactful social care services, which include: 

• Social care coordination 
• Care transition services 
• Transportation for nonmedical needs 
• Meals (beyond limited basis) 
• Food and nutrition resources 
• Services supporting self-direction 
• Private duty care 
• Housing navigation 
• Medication inventory and assessment 
• Chronic disease self-management programs (including diabetes and pain) 
• Fall prevention and movement programs 
• Structural home modifications 
• General supports for living 
• Complementary therapies