501(c)(3) Nonprofit · Los Angeles County

Elder Healthcare Navigation & Stabilization Pilot

Connecting vulnerable seniors to the care they need — reducing ER overuse, avoidable hospitalizations, and failed specialist coordination across Los Angeles County.

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3×
Dual-eligible seniors use the ER 3× more than privately insured patients
68%
Of low-income seniors miss specialist follow-up within 30 days of discharge
$8K+
Average cost per avoidable hospital readmission to health systems
The problem we solve

Why vulnerable seniors fall through the cracks

"Low-income and housing-insecure older adults frequently fail to access medically necessary specialty care because they cannot independently navigate healthcare systems, transportation, referrals, paperwork, or digital systems."

— Senior VP, BHBF
Repeat ER use Seniors return to the ER because follow-up care never happened
Readmission risk Discharge plans fail without navigation support and follow-up
Unmanaged chronic care Diabetes, hypertension, and heart disease go uncontrolled
Social isolation No support system to facilitate care engagement or follow-through
What we provide

Navigation & coordination services

Ben Harris Business Fund does not provide medical treatment. We provide the connections, coordination, and hands-on support that make treatment possible and effective for medically vulnerable elders.

We carefully vet all vendors and partners for quality, professionalism, responsiveness, and cultural competency — so seniors receive reliable support they can trust.

Healthcare navigation

  • Scheduling specialist appointments
  • Referral tracking and coordination
  • Discharge instruction support
  • Care team communication

Transportation coordination

  • Arranging medical rides
  • Accompanying elders to appointments
  • Same-day and scheduled transport
  • NEMT coordination support

Medication & follow-up

  • Pharmacy coordination
  • Appointment reminders
  • Post-discharge follow-up calls
  • Compliance tracking and support

Benefits navigation

  • Medi-Cal & Medicare enrollment
  • SSI and IHSS applications
  • CalAIM Community Supports
  • Housing resource referrals

Digital assistance

  • Patient portal setup & navigation
  • Online scheduling support
  • Telehealth assistance
  • Digital literacy coaching

Community engagement

  • Interactive health workshops
  • Benefits literacy trainings
  • Multilingual sessions
  • Trusted community settings
Target population

Who we serve in Los Angeles County

We specialize in reaching seniors most likely to fall through the gaps of the healthcare system — and most likely to become high-cost, high-utilization patients without intervention.

Medi-Cal eligible seniors Adults 65+ enrolled in Medi-Cal or county-managed care plans who need help finding providers, understanding benefits, and completing enrollment or renewal paperwork before coverage lapses.
Dual-eligible individuals Seniors who qualify for both Medicare and Medi-Cal — often facing conflicting rules, duplicate bills, and confusion about which plan pays for what. We coordinate across both systems so nothing falls through the cracks.
Socially isolated elders Older adults living alone or with few family caregivers who miss appointments, forget medications, or lack anyone to advocate for them during hospital stays and specialist visits.
Housing-insecure older adults Seniors in shelters, transitional housing, or unstable living situations who struggle to maintain a mailing address, store medications safely, or access consistent primary and specialty care.
High ER utilizers Patients with repeated emergency visits — often because underlying conditions, follow-up appointments, or prescriptions were never coordinated after the last discharge.
Cognitively overwhelmed patients Elders with memory loss, limited English proficiency, or low health literacy who cannot manage patient portals, insurance forms, referral slips, or multi-step care plans on their own.
↓ ER overuse
Navigate seniors to the right care before crises occur
↓ Readmissions
Post-discharge follow-up that keeps patients on track
↑ HEDIS scores
Drive follow-up visit and medication compliance metrics
✔ CalAIM ready
HRSN-aligned services for ECM and Community Supports
Why health systems choose us

A trusted community-based care navigation partner

Ben Harris Business Fund is positioned as a healthcare access stabilization and care coordination organization — not an informal advocacy group. We speak the language of value-based care, HEDIS metrics, and CalAIM compliance.

📉
Reduce avoidable costs Lower ER overuse, readmissions, and unmanaged chronic conditions that drive system costs
📋
Move HEDIS numbers Our follow-up and medication compliance work directly improves key performance measures
🏥
CalAIM alignment HRSN-compliant services supporting ECM and Community Supports contracting requirements
🤝
Community trust We reach seniors other organizations cannot — in languages, settings, and formats they trust
Ideal partners
Kaiser Permanente
L.A. Care Health Plan
Health Net
LA County DHS
Hospital Systems
ECM Organizations
Get involved

Ready to reduce costs and improve outcomes for vulnerable seniors?

We are actively seeking partnerships with health plans, hospital systems, and CalAIM organizations in Los Angeles County. Let's discuss how Ben Harris Business Fund can support your quality goals.

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Contact us

Ben Harris Business Fund

Service area Los Angeles County, California
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