Healthy Lives Care Integration

Coordinating care for complex challenges.

Healthy Lives helps people with dual diagnoses–serious mental illness and chronic medical conditions—stabilize and improve their health. 

A pioneering Brookline Center program, Healthy Lives treats adults who face multiple mental health and medical challenges which often lead to use of emergency care. Healthy Lives pairs case managers with nurse practitioners to integrate services, manage disease, and introduce wellness activities, all designed to fit each patient’s specific conditions and abilities. The program partners with local hospitals and community health centers; we work with 34 agencies to provide the ideal mix of services, as needed.

Healthy Lives improves client health: we see reductions in blood pressure, diabetes, and obesity, alongside improved nutrition, exercise, and regular attendance at mental health appointments. Because Healthy Lives patients experience fewer hospitalizations and use their primary care doctors instead of emergency rooms, the program also reduces healthcare costs.

How It Works

Healthy Lives provides a mobile team of a nurse and community outreach workers. Together with each patient, they assess, prioritize, and coordinate health and social needs. They also coach each patient in self-care and wellness, so that people can better self-manage their conditions.

Most individuals served by Healthy Lives are adults age 30-70 with serious mental illness (such as depression, anxiety, or psychotic disorders) and two or more chronic health conditions (such as diabetes, heart disease, or kidney disease). Their complex medical histories, behavioral health issues, and social and environmental challenges, including food insecurity, lack of transportation, or, at times, some substance abuse, can lead to missed appointments, poor adherence to prescribed treatment plans, and frequent crises. On average, these patients experience seven hospital admissions and eight emergency room visits each year.

By integrating all aspects of the person’s health and living situation, building a team around the person, and expanding the roles of care coordination, patient education, and peer support, Health Lives dramatically improves the health and wellbeing of these adults, reduces hospital and emergency room utilization, and decreases the overall cost of health care.

Counting on Care

35%

Healthy Lives patients have 35% fewer emergency room visits, 19% fewer hospitalizations, and 27% fewer missed healthcare appointments on average.

80%

Because 80% of Healthy Lives patients have very low income, philanthropy sustains this program.

$22,000

Healthy Lives has helped 86% of hypertensive patients control blood pressure, 71% of diabetic patients lower blood sugar, and 50% of patients lose weight, reducing annual healthcare costs by an average $22,000 per patient.