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Community Resource Hubs
Our Community Resource Hubs (CRH) help organizations coordinate programs and connect residents to services and supports.
Ensuring Health Equity Through Coordinated Care
The Community Resource Hubs (CRH) are person-centered care coordination networks developed by ARCHI to streamline referrals between healthcare providers and community-based organizations. They foster rapid referrals and data sharing between Community Resource Hub network partners and shift the burden of navigating services away from individuals and onto a coordinated system of care.
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The CRH network is core to the way ARCHI advances health equity all across metro-Atlanta.​ It connects residents of neighborhoods like downtown Atlanta, the Old Fourth Ward, and Chamblee to the resources needed for personal well-being. ​
Behind Every Referral is a
Life Changed
“I didn’t know who I was—now I do.”
When Wendy arrived in Atlanta with no home, no local connections, and undiagnosed chronic pain, she didn’t expect to find an advocate like Senge—a community health worker (CHW) at Mercy Care connected to ARCHI’s Community Resource Hub.
What began as a simple dental visit quickly unfolded into coordinated help with housing, nutrition, medical care, and even recovery of her birth certificate. Through the Hub’s real-time referral system and Senge’s compassionate support, Wendy was able to manage her blood pressure, address her chronic pain, reconnect with her identity, and stabilize her life. Her story shows what’s possible when systems align around people—not the other way around.
How The Hub Network Coordinates Partners
Community Health Workers
CHWs are embedded in partner hospitals and clinics, providing one-on-one support to patients in navigating healthcare and social services.
Partner Network
Hospitals, clinics, and community-based organizations collaborate through monthly case conferences, resource-sharing, and streamlined referrals.
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Health Systems Partners
Hospitals and Federally Qualified Health Centers (FQHCs) integrate CHWs into their teams, improving referrals, patient tracking, and interoperability.​​​
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Our Community Resource Hubs Make a Difference
Connecting high-needs residents to community health workers has produced remarkable results.
Improved Health Outcomes
Patients experience better chronic disease management (e.g., improved blood pressure, weight, and blood sugar levels).
Smarter Healthcare Utilization
Reduced emergency room visits and hospitalizations for chronic conditions.
Increased Access to Services
Patients receive housing, food assistance, and employment support.
Designed to Invert the Burden
​​When organizations came together to form ARCHI in 2012, they identified 7 critical issues that, if tackled collaboratively, could significantly improve health outcomes, reduce healthcare costs, and grow the metro Atlanta economy. While all these issues remain essential to health transformation, person-centered care coordination that addresses socioeconomic needs essential to well-being has risen as a central strategy in ARCHI’s work.
ARCHI and its partners work to invert the burden of navigating complex and siloed services away from residents and onto service providers. Thusly, ARCHI is building a system of care that meets people where they are, centers individuals and families, and addresses a full range of issues so Atlantans can stabilize and thrive.
CRH Impact Highlights
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39%
Decrease in emergency room visits and inpatient admissions at partnering hospital.​
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91%
Of patients in need of nutrition education were connected to relevant programs.
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86%
Of patients lowered their blood pressure, as reported by a partnering Federally Qualified Health Clinic.
