Coordinate Care
Care coordination software for whole-person care
Relay gives care teams one record for each member—screenings, needs, care plans, referrals, tasks and outcomes—so the next step for every member, and who owns it, stays visible.
Who it serves
- Care coordinators and community health workers
- Supervisors and program managers
- Community partners delivering services
- Network leads accountable for outcomes
Member 360
One longitudinal record for every member
Needs, screenings, care plans, referrals, consent, documents, the care team and history sit in one member record. The Action Center ranks what needs attention now, and coordinators accept, snooze or dismiss each item.
- Available: Timeline and history in one place
- Available: Care team, documents and case notes in the same record
- Available: A what-matters-now view that ranks open work
- Available: Tabs shown according to each user's role and permissions
Households & family
See the family, not just the individual
Record typed family relationships on each member and guardian consent for minors. Where your organization switches it on, household records add membership, a primary contact, a duplicate check and a shared timeline of needs, referrals and outreach.
- Available: Family relationships on the member record
- Available: Guardian consent for minors
- Household records with a shared timeline
Intake & screening
Screen for health-related social needs, consent first
Coordinators and partners run PRAPARE or AHC-HRSN screenings—your organization chooses. Consent is recorded before the first question, positive answers become needs, safety answers raise alerts, and re-screening timing rules are enforced.
- Available: PRAPARE or AHC-HRSN instruments
- Available: Corrections, and imports of screenings done elsewhere
- Assisted intake that finds or creates the person and household
- A public self-screening link for your community
Assessments
Assessments that end in a plan, not a form
Standard, HRSN and reentry assessment packages enforce required questions, flag safety concerns and recommend services for each identified need.
- Available: Required-question completion rules
- Available: Safety alerts
- Available: Service recommendations for each need
Eligibility & benefits
Check eligibility and point members to benefits
Every eligibility check records whether its result came from a live source, so no one mistakes a guess for coverage. Benefits navigation gives an indicative pre-screen for nine federal programs and tracks the applications staff help members start.
- Eligibility checks through your clearinghouse connection
- Available: Indicative pre-screen for food, energy, family, and health coverage programs
- Available: Application tracking and prepared forms
Care plans & goals
Care plans that turn into assigned work
Start from a template, set goals and interventions, and let each intervention create tasks. Relay suggests plan items from needs, assessments, referrals and outcomes; a coordinator reviews every suggestion before it is added.
- Available: Plan templates
- Available: Goals and interventions that create tasks
- Available: Suggested plan items, reviewed by a person
- Available: Plan closure and PDF export
Closed-loop referrals
Referrals that come back with an outcome
Send a referral to a partner, track acceptance, wait lists and scheduling, and close the loop with a recorded outcome. When a partner frees capacity, the oldest wait-listed referral moves forward automatically.
- Available: Accept, partial accept, decline with a reason, transfer and reopen
- Available: Wait lists with automatic promotion when capacity opens
- Available: Stalled referrals flagged after 14 days
- Ranked provider suggestions for a need, with reasons
Tasks & caseloads
Balanced caseloads and work that doesn't get lost
A task workbench with bulk assignment and deferrals, a caseload for each coordinator, and a supervisor rebalance plan built from member complexity and coordinator capacity—applied only when a supervisor accepts it.
- Available: Task workbench with bulk assignment
- Available: Caseload views for each coordinator
- Available: Rebalance plans that a supervisor accepts or rejects
Supervisor oversight
Team workload, escalations and approvals in one view
The supervisor dashboard brings team workload, huddle preparation, escalations and approvals together. Escalations move from acknowledged to resolved, and nudging a partner creates a real task.
- Available: Team overview and huddle preparation
- Available: Escalation queue
- Available: Service authorization and agent approvals
Justice & reentry
Coordinate reentry with consent and clear limits
A reentry workspace queues members returning to the community, each with an eight-milestone reentry plan and a reentry assessment. Justice data stays behind consent and role checks and is never used in risk scores. Justice events are recorded through Relay's API; there are no justice-system integrations.
- Available: Reentry work queue for coordinators and supervisors
- Available: Eight-milestone reentry plan and reentry assessment
- Available: Justice and reentry coordination report
- Follow-up tasks from milestones, which can be automated
How it connects to the rest of Relay
- Operate Your Network
Referrals go to partners whose capacity, contracts and readiness you manage.
- Engage Members & Equip Teams
Outreach, texting and calls reach members between visits.
- Manage Performance & Finance
Recorded outcomes feed quality and value-based measures; delivered services flow to authorization and invoicing.
- Connect Data & Intelligence
Consent, identity matching and integrations keep the record complete and governed.
See care coordination in Relay
Bring a real member journey—from screening to outcome—and we'll walk through it with you.
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