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Patient-focused Services

Patients enrolled in value-based insurance programs that use the CHI Health Partners network have access to our team of health care professionals offering clinical programs and resources which serve as an extension of the patient’s primary care provider.  These resources include:

Care Coordination

Our interdisiplinary team of clinicans work in CHI Health Partners affiliated acute and ambulatory settings to help chronically ill patients navigate complicated issues like diabetes and high blood pressure.

Deliberately organizing patient care activities and sharing information among all participants achieves safer, more effective care with infrastructure and tools that focus on improving the health of patients with chronic conditions.

Nursing Home Network

CHI Health Partners works with a specially selected network of skilled nursing facilities and provides our patients with an on-site nurse practitioner to care for them during their skilled nursing stay. The nurse practitioner develops, coordinates and executes a plan of care for each patient, providing more support to maximize their rehabilitation. This program is currently limited to operation in the Omaha metro area. 

Transitions of Care

CHI Health Partners' team of nurses and care coordinators provide extra support to patients following hospital stays. The team provides regular follow-up with patients to assist in securing PCP follow-up appointments, post-discharge medication review, and the initiation of services such as home health or durable medical equipment delivery.

Pharmacy Assistance Programs

Pharmacists and Medication Coordinators work with providers to optimize medication therapy, resolve medication-related problems, provide medication therapy management in patients with complex conditions and help providers and patients navigate pharmaceutical company application processes for many brand-name medications.

The Medication Access Program (MAP) fills more than 6,000 prescriptions for more than 2,000 patients in a typical year, for an annual savings to our patients of approximately $13 million.


Registered dietitian nutritionists work with affiliated primary care clinics and population health coaches to address dietary issues related to diabetes, weight management, high cholesterol, kidney disease and enteral nutrition.

Social Support

Social workers and community health workers help patients address problems that interfere with their health, such as financial, legal, housing, mental health and family issues.