Provides a program that connects hospital patients and health care providers for better overall health of the larger community through case management. There are multiple factors that contribute to an individual's health, including social determinants like culture, race, income, and education level. Certified Community Health Workers assist vulnerable and high-risk individuals who are seeking care and assistance from agencies that provide medical, behavioral health, education, employment, and social services. They help the patient streamline the process by connecting information for all stakeholders who are trying to impact the healthcare experience in the community.