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Ottawa Pathways to Better Health

Do you know someone who may benefit from a Community Health Worker?

Make Referral

No fee for qualifying individuals.


Call (616) 393-5601

A program designed to assist people with accessing community services,
to improve health outcomes and decrease unnecessary hospitalizations
and emergency department visits.

For more information about the program, please call (616) 393-5601

Eligibility Criteria

  • 18 years of age or older and live in Ottawa County
  • Enrolled in or eligible for Medicare and/or Medicaid
  • Have two or more chronic health conditions
    (such as diabetes, depression, anxiety, heart disease, arthritis, asthma, hypertension, or long-term pain)
  • And have challenges overcoming barriers to manage health conditions
    (such as accessing medical care and preventive health care services and accessing resources to reduce hospitalizations and ED visits).

Community Health Workers

(CHWs) are trusted members of your community who understand your needs and will serve as a link for you to health and social services. A CHW will:

  • Meet with you at your convenience,
  • Help you set goals,
  • Guide you through the health care system,
  • Link you to medical care for your specific needs
    (primary, dental, specialty, mental health, substance abuse treatment)
  • Help you manage your health conditions and prescriptions,
  • Help you reduce hospital and emergency room visits,
  • Link you to community services and resources
    (food, clothing, housing, financial and utility assistance, transportation, education, employment),
  • and much more.