Reinventing Rural Health
Main Street Health partners with existing primary care providers in rural America to make the transition to value-based care.
We Work With All Types of Rural Providers
- Small Independent Private Practices
- Large Group Private Practices
- Rural Health Clinics
- Critical Access Hospitals
- Community Health Centers
- Health Systems
We Value Community
We understand the value of community and building trusted relationships, and that is why we are present in each community we serve. We do that by embedding a local Health Navigator in every practice and hiring local teams in every market we serve.
A Health Navigator is an extra set of hands to assist you with doing all the little things you need to do every day to deliver the best possible care to the patients in your practice.
Meet Dr. Commie Hisey
Dr. Hisey is partnering with Main Street to deliver high quality care in Texas.Watch Video
Meet Dr. James Batey
Dr. Batey explains how Main Street is improving his care team's productivity in Obion County, Tennessee.Watch Video
Meet Dr. Jennie Eckstrom
Dr. Eckstrom is partnering with Main Street to provide new resources to her team and patients in Montana.Watch Video
Meet Dr. Timothy Smith
Dr. Smith is partnering with Main Street to help his team prioritize their focus on patient treatment and care planning in Iowa.Watch Video
Meet Amy Smith, PA-C
Amy is a physician assistant partnering with Main Street to ensure her patients receive the care they deserve in West Tennessee.Watch Video
Meet Dr. Wess Blackwell
Dr. Blackwell is partnering with Main Street to prepare for the transition to value-based care in Fayette County, Texas.Watch Video
Local Health Navigator
Our Health Navigators are local to your community! Our Health Navigators provide an ‘extra set of hands’ in the clinic to help patients navigate care and reduce burden on the clinic staff.
Data-driven assessments are completed during routine visits to identify clinical needs and treatment pathways for prevalent rural conditions.
Closed-loop workflows ensure providers and Health Navigators address open HEDIS / STARs quality gaps.
Community Resources Coordination
Navigators surface social determinants of health barriers (e.g., food, transportation, housing, financial assistance) through patient check-in visits and connect patients with local and federal resources to close gaps.
Health Navigators provide expertise and education on chronic conditions, medication adherence and understanding and maximizing their healthcare benefits including government-funded subsidies and cost-sharing for which they qualify (e.g., LIS).
Transitions of Care
Health Navigators review patient hospital admissions and discharges with clinic staff and conduct patient outreach to schedule timely follow-up care.
Navigators work in clinics alongside staff to assist with care coordination, patient education, and value-based care activities.
Our Navigators are enabled by best-in-class technology.
Fragmented and complicated data systems make getting the right information at the right time difficult for providers and patients.
Main Street maintains integrations across the healthcare ecosystem to digest and organize data.
Main Street Technology
Navigator Provider Partnership
Delivering you the insights you need to manage your patients’ health and conditions.
High Risk Patient Engagement
Surface relevant clinical information at the point of care while real-time notifications prompt proactive outreach to patients to improve transitions of care and reduce readmissions.
Closed Loop Workflows
Customized closed-loop workflows drive patient engagement, care coordination, and gap closure.
Daily, weekly, and monthly reports are provided to providers and practices to monitor trends and performance.