About Us

Community Care Management Partners (CCMP) is a lead Health Home in New York City, providing high intensity field-based care management to over 15,000 New Yorkers annually. CCMP was formed in 2012 and is a network of 45 highly experienced organizations focused on providing quality health services to New Yorkers across the five boroughs. Some of our member organizations operate federally qualified health centers and hospitals to meet the ever changing medical and/or mental health needs of the communities we serve.

Our Goals

CCMP helps chronically ill New Yorkers navigate and access healthcare and social services to improve their health and wellbeing. Through our comprehensive community-based network, we offer person-centered, high-quality, and cost-effective care coordination services that promote stability, autonomy, and dignity.

What Makes Us Stand Out?

CCMP partners with a wide range of reputable and unique Care Management Agencies you know and trust, that provide services to our members in a multitude of languages in all five boroughs of NYC.

The Health Home Care Manager focuses on providing personalized, holistic care designed to meet your specific needs. The Care Manager creates relationships with your medical providers, coordinating care and serving as a “home base” helping you get the best care possible, so that you feel and live better.

The world of Health Homes can be confusing; there are many options available to you, so making the best decision can be difficult. Contact us if you have any questions or would like more information.

Our Care Management Agencies

Mount Sinai Morningside

Mount Sinai Morningside CMA is part of the greater Mount Sinai Hospital network. Prior to becoming a CMA our program was established as the sole Manhattan based Home and Community Based Services (HCBS) Waiver program under the NY State Office of Mental Health. As an HCBS Waiver program, we were designated to provide intensive in-home community based supports to seriously emotionally disturbed (SED) children, youth and their families. With the roll out of Health Homes, our team took decades of extensive experience in the delivery and management of mental health services and created a children’s CMA which specializes in working with children and adolescents who struggle with mental health challenges. Our expertise in this field allows us to serve our families with a superior level of professional knowledge and community resources.

Due to our linkage with Mount Sinai Hospital, we are fortunate to be connected to an expansive network of medical and mental health providers. As part of the Child and Family (CFI) Institute, we partner with our own internal outpatient mental health services and Child and Family Treatment and Support Services (CFTSS) program, which offers Family Peer Support Services (FPSS), Other Licensed Professional (OLP) and CPST (Community Psychiatric Supports and Treatment), the CARES program – a therapeutic day program for SED youth and the Parent Infant Center (PIC). Additionally, we were awarded 9 non-Medicaid care management slots by Department of Health Mental Health (DOHMH) and provide ongoing care management to these families as well. In our Health Home program we have approximately 250 members receiving services from Care Managers, many of whom are licensed Social Workers, trained in evidenced-based treatment.

Our approach to care management is both holistic and individualized. Our philosophy uses the Child Adolescent Services Systems Principles (CASSP) to focus on the strengths and needs identified by the families. In collaboration with a child and families’ home community and systems, we offer strength-based, child-specific and culturally competent care which emphasizes the need for services in the least restrictive setting possible. We understand how critical it is to identify and treat children and families’ complex psychosocial and health issues in the earliest possible stages. Due to the complex mental health needs of our members, we believe a strong clinical foundation is crucial for providing exemplary care coordination.

Little Treasures

Little Treasures-Petits Trésors, SLP, PLLC, is dedicated to providing exceptional services. We take great care in doing so for all concerned parents who have children with immediate therapeutic needs in areas of speech and language therapy, occupational therapy, physical therapy, psychology, applied behavioral analysis (ABA) and care management services for children with intellectual and developmental chronic conditions. Our main objective is to exceed each client’s expectations, thereby providing a strong foundation for return clientele, and continuing an endless odyssey embedding the following values: Excellence, Respect, Teamwork, Efficiency and Integrity.

We provide service coordination, core and supplemental evaluations, and home/community-based services to children in Early Intervention. In our Health Home Care Management program, our care managers advocate for obtaining health care providers, obtaining mental health and substance abuse providers, monitoring medications, assistance in applying for housing, social services (such as food benefits, SSD, locating transportation, after-school programs, etc.), connecting members to their community for social supports and other assistance.

BCCS


Bilingual Coordinated Care Services, Inc. (BCCS) provides exceptional Case Management services. We take great care in doing so for all concerned clients who have immediate medical/mental health needs, social services and/or other community support needs.

Our main objective is to exceed each client’s expectations, thereby providing a strong foundation for returning clientele, and continuing an endless odyssey embedding the core values: Excellence, Respect, Teamwork, Efficiency, and Integrity.

We take great pride in ensuring our care managers provide culturally competent, person centered, and trauma-informed care to clients. We strive to understand the triggers of trauma survivors and help them avoid re-traumatization, while also helping them manage their chronic conditions: SMI, SED, Complex Trauma, HIV/AIDS, and SUD and reducing the frequency of ER/Hospital visits.

Lifeline

Lifeline Center for Child Development aims to empower children to develop and use their behavioral tools so that they may reach their full potential in academic, social and family arenas during childhood, and go on to live their full potential in adulthood.

At Lifeline, children with mental illness, and their families, will find the resources to meet their needs, from early childhood through early adulthood, in a nurturing, progressive, and informed environment focused on their full health and wellness. Lifeline offers psychiatric day treatment services, family wellness instruction, care management for children, and trauma-focused clinic services.

 

UHP


Urban Health Plan is a system of federally qualified community health centers that delivers primary and specialty care services to more than 84,000 patients and employs nearly 1000 associates and providers. The system has served the community since 1974 through twelve satellite health centers—including one site in Corona, Queens and one in Central Harlem—twelve school-based health centers, two mental health facilities and ten administrative and program sites. Urban Health Plan is Joint Commission accredited.

Among the organization’s unique and innovative programs are: The Center for Healthy Aging, which offers an integrated approach to caring for the most vulnerable geriatric population; the Nurse Practitioner and Physician Assistant (NP/PA) Residency Program; Workforce BX; the Institute for the Advancement of Community Health (IACH); the Community-Based Research Center and the Institute for Learning and Development.

Housing Works


Housing Works is a healing community of people living with and affected by HIV/AIDS. Our mission is to end the dual crises of homelessness and AIDS through relentless advocacy, provision of lifesaving services, and entrepreneurial businesses that sustain our efforts. Born out of the Housing Committee of ACT UP New York in 1990, Housing Works was founded on the premise that housing is the threshold step for improving the emotional and physical health of homeless people living with HIV/AIDS, irrespective of disease advancement, mental health issues, or addiction.

Today, the organization serves over 12,000 clients annually in the five boroughs of New York City through a constellation of housing, primary and mental health care, Health Home Care Management, other case management programs, harm reduction services, and job training, and it is nationally recognized for its fierce advocacy on behalf of its member communities through organizing, policy, research, and litigation efforts.

Housing Works is a healing community of people living with and affected by HIV/AIDS. Our mission is to end the dual crises of homelessness and AIDS through relentless advocacy, provision of lifesaving services, and entrepreneurial businesses that sustain our efforts.

Born out of the Housing Committee of ACT UP New York in 1990, Housing Works was founded on the premise that housing is the threshold step for improving the emotional and physical health of homeless people living with HIV/AIDS, irrespective of disease advancement, mental health issues, or addiction.

Today, the organization serves over 12,000 clients annually in the five boroughs of New York City through a constellation of housing, primary and mental health care, Health Home Care Management, other case management programs, harm reduction services, and job training, and it is nationally recognized for its fierce advocacy on behalf of its member communities through organizing, policy, research, and litigation efforts.

Emma L. Bowen Community Service Center

 
The Emma L. Bowen Center’s Care Management mission is to help improve the individual or family’s quality of life by addressing medical, mental health, substance use, and other social determinates of health; also, to reduce ER visits and hospitalizations. Our care managers serve as advocates for our patients, connecting them to needed services such as physicians, nutritional services, behavior health services, entitlements and benefits, food stamps, legal services and rehabilitation services.

Care managers can also serve as mediators in disputes, family conflicts and help in identifying and mitigating environmental challenges.

Care management services aims to develop individual soft skill that enable patients become self-sufficient and develop a more stable lifestyle by reducing their psychiatric hospitalizations and health-related hospitalizations, providing assistance with access to legal, assisting with paperwork to help clients avoid accidental reduction in benefits, and working to enable clients to maintain a more stable lifestyle.

ACI


ACI Rehab operates several NYS OASAS licensed facilities, offering addiction recovery services such as Medically Supervised Withdrawal and Stabilization Services, Inpatient Rehabilitation, Outpatient programs, and IOS/IOP services.

Since 1968, ACI has been a leading preferred addiction-recovery partner of patients and service providers in the region.
ACI is #1 in Second Chances!

NADAP


Founded in 1971, NADAP is a private nonprofit social service organization dedicated to helping New Yorkers from underserved communities enhance their lives.

We deliver a range of wraparound services, including job preparation & placement, care management, health insurance enrollment, substance use assessment, and professional training.

Harlem United


Harlem United advances health equality with healthcare, housing, and harm reduction. Activists founded Harlem United in a church basement in 1988. At a time of extreme stigma, they created a compassionate community for loved ones dying of AIDS. Today, Harlem United provides world-class HIV care.

And over the years, we’ve expanded to provide services for many other healthcare needs. We’ve advocated for social justice and remained rooted in our community. We’ll keep at it until we achieve health equality.

Hudson Heights IPA


Hudson Heights Independent Physician Association (“Hudson Heights IPA”) founded in 2007 by a group of physicians with extensive experience in community-based primary care. We serve patients in the five boroughs of New York and give provider members the tools to stay independent and enhance their performance by participating in value-based care. Our track record exceeds 4-star quality in HEDIS and Medicare Star ratings while achieving shared savings for our physician network.

We are committed to providing high-quality care to our patients in the most cost-effective manner and work hard to deliver outstanding service and affordable healthcare to our diverse communities. We operate a Care Coordination Program for patients who need assistance to improve their health by providing access to an array of services to stay out of the hospital.

We participate in the Health Home Program and have Care Coordinators placed in the medical offices who provide services in the following areas:
• Assist patients with medical appointments and treatment adherence,
• Ensure that patients are linked to all medical services,
• Provide patients with entitlements assistance, and much more!

CCN Medicine


At CCN Care Management Agency, supports children and adult Medicaid recipients. Operating within a robust private healthcare network spanning the Bronx and Manhattan, our dedicated team comprises Care Managers, Registered Nurses, Health Promotion experts, Community Health Workers, and Social & Mental Health Support personnel. We prioritize holistic care, ensuring collaboration with providers and family members to address every aspect of our clients’ well-being. Our goal is to help maintain individual health, reduce emergency room visits, and prevent hospitalizations. Our services encompass Comprehensive Care Management, including outreach, needs assessments, crisis intervention, and care planning, conducted in collaboration with multidisciplinary teams.

We provide Care Coordination and Health Promotion Services to ensure adherence to treatment, linkage to necessary services, and support during appointments. Additionally, our Comprehensive Transitional Care Services focus on maintaining continuity of care during transitions between services, including hospital admissions and discharges.

Member Support Services entail consultation on advanced directives and rights, interpretation services, and referrals to peer support, social services, and entitlement programs. We also facilitate connections to Community and Social Support Services by identifying available resources and actively managing referrals and engagement.

JEMCare

Established in 2018, JEMCare has been steadfast in its commitment to serving communities with excellence and inclusivity. Our dedication to delivering unparalleled support is evident through our Health Homes Care Management Program, which currently supports over 3000 adults and children, providing them with the care and resources they need to thrive.

Diversity and inclusivity are at the heart of our agency. We are deeply committed to reaching historically underserved populations, ensuring that everyone has access to the quality care they deserve. Our team reflects this commitment, with a majority of bilingual staff proficient in over 15 languages and dialects, bridging communication gaps and fostering understanding.

At JEMCare, we go beyond traditional care services. Our Health Home and HH+ programs offer comprehensive support, tailored to the unique needs of each individual we serve. Additionally, JEMCare was designated as an HCBS provider agency in 2022, marking a milestone in our journey of expanding our reach and enhancing our offerings to better serve every community.

JEMCare is honored to be a part of the CCMP family and to support the agency’s mission and goals.

ACMH


ACMH is committed to the mental and physical wellbeing of vulnerable New Yorkers and is a leader in the provision of outreach and engagement, care management, rehabilitation, crisis support, and supportive housing.

ACMH is committed to becoming an anti-racist organization and seeks to promote actionable change to create an intentional culture of equity at individual, interpersonal and institutional levels.

Our Owners

CCMP is owned by an equal partnership of 8 healthcare non-profit organizations who serve the New York City community. It is comprised of VNS Health, Mount Sinai, Community Healthcare Network, Sun River Health, Urban Health Plan, Institute for Family Health, Argus Community Health, and the iHealth collaborative.
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Our Staff

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Nathan Ito-Prine

MHA, Chief Executive Officer

Nathan has been working in Health Homes since its inception in 2012. Nathan brings a wealth of Health Home experience including 3 years as a Health Home care manager within the CCMP Health Home. Nathan’s focus is bringing creative data driven solutions to bear in the Health Home space in order to maximize the quality of service the CCMP Health Home can provide to both the network of CMAs as well as the members we serve.

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Ana Tabachneck

MSEd, LCSW, Chief Policy and Compliance Officer

A professional social worker and rehabilitation counselor, Ana has worked with the CCMP team since 2018, overseeing the Quality Management Program and Compliance functions of the Health Home. Ana got her start supporting people with SPMI (Serious and Persistent Mental Illness) who were experiencing homelessness both in and out of the NYC shelter system. After many years in the world of ACT Teams, OMH CR-SROs, and DHS shelters, Ana pivoted to Health Home Care Management and Quality Assurance. Ana enjoys helping our Network Care Management Agencies identify areas for improvement, including using technology support those improvements. Ana helps translate state policies and MCO (Managed Care Organization) expectations into easily understandable policies and trainings. Ana works with other Health Homes, New York State Department of Health, and our MCO partners to streamline policies so that our CMAs have room to do what they do best…help our members.

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Stephen Huntley

MPA, Senior Quality Specialist

Living and working within the fast-paced environment of New York for the last four+ decades have shaped my worldview and professional endeavor in the most profound ways. Ever since I began my profession, I’ve been serving a variety of populations, comprehending their distinct needs, and co-functioning with them towards their healthy progression. From the past decade in particular, my focus has been directed towards improving quality healthcare within the Health Home domain, a task I’ve undertaken since 2013, steering it diligently towards betterment from 2015 onwards. One aspect that significantly impacted my practice has been working with Health Homes. Since 2013, my work in this area has allowed me to innovate and improvise, ensuring that quality healthcare is not a privilege but a right accessed by all. My work involved syncing a variety of health care services under one, streamlined structure, making healthcare access effortless for those in need. The Health Home model, emphasizing a patient-centered approach, has consistently proven to be instrumental in managing chronic conditions while being cost-effective. My stoic commitment to healthcare quality enhancement culminated in my shifting fully to working within Quality since 2015. This marked an exciting phase in my career, wherein I merged my understanding of healthcare dynamics with quality standards. Fortifying the health sector’s quality has become a primary aim, further escalating the effective health outcomes for the different populations. Regarding my future, the wisdom gained through these experiences emboldens me to continually innovate and improve to serve all populations adroitly and effectively. This personal journey towards the pursuit of quality healthcare for all stands not merely as a career but as a commitment to serve my community at large.

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Tavin Weeda

MSDS, Data Scientist

Tavin earned his M.S. in Data Science from Southern Methodist University and today applies that expertise to enhance CCMP’s operational efficiency and foresight. In his role, he focuses on the practical applications of AI, using predictive modeling, the capabilities of unsupervised learning and ever-evolving Large Language Models to gain valuable insights. This work is in tandem with his commitment to enhancing CCMP’s reporting through thoughtful automation, providing the network with actionable information that would otherwise remain obscured. His approach is not just about maintaining seamless operations today but also innovatively preparing for tomorrow’s technological challenges in the Health Home world.

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Zulema Solorzano

Administrative Coordinator

Zulema is the Administrative Coordinator for CCMP Health Home. My work experience is mainly working with children and their families. I worked for five years in a non-for-profit organization as an Activity Specialist for the after school and summer school programs. I then graduated from Hunter College with a BA in liberal arts and started working for an early intervention program as an Administrative Assistant for two years. For me to expand my knowledge and have the ability to help serve a broader population, I decided to join CCMP Health Home. I am happy to say that I now have five years working with CCMP. My focus is to ensure that my health home team and our care management network receive the proper information and support to deliver the best services our members deserve and need for a stable and healthy life.

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Robert Ward

MPA, Network Coordinator

Robert Ward is the Referrals and Network Coordinator at CCMP. Robert has over 20 years of experience working with public/private partnerships to improve service delivery in underserved communities. An able manager with an extensive background in behavioral health, Robert welcomed the opportunity to join CCMP in 2022. Robert spent many years on the frontlines supporting families with medical and mental health challenges. He oversaw various initiatives designed to address substance use disorders and unemployment. These programs provided the perfect mix of putting people to work and reducing external stressors. Robert holds a bachelor’s degree from Baruch College and an advanced degree from Alfred University. Robert is a dedicated professional who developed the necessary skills over the years to connect individuals to care and improve health outcomes.

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Ana Mejia Placencio

Quality Specialist

Ana Mejia Placencio is a Quality Improvement Specialist assigned to children. I’ve been working in care manager agencies/ health homes since 2018. My experiences before comprehensive care management were in a non-profit organization that assists women in their career path, especially in the health allied field. I have a bachelor’s degree in hotel administration from the Dominican Republic. I’m currently pursuing my second bachelor’s degree in health service administration. I’ve been part of CCMP since 2022, providing proper guidance to care managers and supervisors and ensuring the CCMP policies and procedures are followed. I’m glad to be part of this amazing company.

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Regina Christoforatos

Quality Specialist

Regina Christoforatos is a Quality Improvement Specialist with CCMP. I work with a CMA in the Adult Home Plus (AH+) program which is a more intensive care management program established by the NYS Department of Health. I also work with Adult CMA’s that service members in Health Home Plus (HH+). HH+ is an intensive care management program for Serious Mental Illness or HIV. My experience prior to working with CCMP was working in various roles since 2013 with a Care Management Agency. I started working with CCMP in September of 2022. With limited knowledge in my role as Quality Improvement Specialist, proper leadership, and guidance from within the agency taught me that I serve an important role regulating company-wide compliance. I also gained the knowledge and skills from CCMP leadership to conduct audits, evaluate compliance with quality standards, policies, and procedures and other various skills that will help me thrive in this position today and in the future.

Contact Us

Contact CCMP to learn how we can help you today!