Flourish: Healthcare Providers 

We specialize in helping adults with multiple chronic conditions
improve their life satisfaction through a comprehensive care navigation program. 



Care Model



About the Flourish Program

Interdisciplinary Case Conceptualization MeetingThe Flourish Program delivers interdisciplinary patient-centered care coordination to adults with multiple chronic conditions living in rural Kentucky. This program uses health care navigation to link patients’ clinical & behavioral health care plans with comprehensive community care plans. We work with patients and their primary care providers to develop a customized care coordination plans that address over six determinants of health.

Patient care plans are reviewed by a wide variety of specialists and field experts upon intake and again at 3-months and 6-months. We utilize Project ECHO to facilitate the "Case Conceptualization Meetings" via telecommunication. 

How We Can Help Your Patients

Our program and care coordination model are based on the latest research in care coordination, interventions, and assessments to help patients improve their health and life satisfaction. Learn more about the evidenced-based research supporting our approach and our validated "Flourish Index."

Patients in the Flourish Program receive the following services:

  • Assigned a trained healthcare navigator who will create and implement an 
    interdisciplinary care plan, including coordinating community-based
    support services
  • Connection with community resources
  • A comprehensive geriatric assessment within the comfort of their home
  • Effective behavioral health interventions
  • Wellness support that addressing six determinants of health
  • Education about health conditions
  • A medication management consultation 

How We Can Help Your Practice

We help healthcare providers identify and better manage high utilization patients with two or more chronic diseases.

We help practices to achieve 1) Improved patient outcomes; 2) Decreased chronic disease burden to your practice; 3) Effective leveraging of CPT billing codes; and 4) Improved work-life for your team. 

For our partnering practices, we assign a practicum student to your practice who is being trained in the latest care coordination and behavioral health modalities. Our students are able to then work with your team to provide care coordination to the patients part of the Flourish Program and are available to provide behavioral health interventions. 

Become a Partnering Practice

Becoming a partnering practice with the Flourish Program enables you, your practice, and your patients to enjoy the full scope of the benefits that embedded care coordination and behavioral health interventions can bring. Partnering practices are expected to 

  1. Help identify and refer potential patients to the program
  2. Participate in interdisciplinary care planning sessions for your patients
  3. Allow us to help increase job satisfaction for your whole team

 Below is an interactive map of our current partnering practice in the Flourish Program.


Contact Us to Learn More