DNG Health
Supporting Healthcare Teams With Community Stabilization and Population Health Coordination
Our stabilization program supports healthcare teams by coordinating housing, transportation, benefits, and community resources to improve continuity of care and reduce avoidable readmissions
Safe Transitions After Discharge
DNG Health partners with skilled nursing facilities, hospitals, and care teams to support residents who face barriers after discharge. Our stabilization program helps individuals safely transition back into the community by coordinating housing navigation, transportation, benefits access, and community resources.Our goal is simple: ensure residents leave the facility with the support they need to remain stable in the community. We support organizations such as:• Skilled Nursing Facilities (SNFs)
• Rehabilitation Centers
• Hospitals & Discharge Planning Teams
• Medicare Advantage Care Management Programs
• Community Housing & Support Providers
A Structured Stabilization Support System for Care Teams
DNG Health integrates with existing care team workflows through a structured referral and communication process designed to support coordination between healthcare providers, community resources, and stabilization services.Our approach is designed to complement the work of care teams by managing key aspects of community stabilization through a coordinated framework that connects healthcare providers, community partners, and support services.Through this infrastructure, our team helps organize and coordinate services related to housing navigation, transportation planning, benefits support, and community resource engagement while maintaining communication with care teams throughout the process.This structured approach allows healthcare organizations to extend their support beyond the clinical setting while maintaining continuity, coordination, and visibility across stabilization activities.
When Residents Are Ready for Discharge, But the Barriers Remain
Discharge teams and social workers often manage complex transitions for residents who are medically ready to leave care but still face challenges outside of the clinical setting. Housing instability, transportation gaps, delayed benefits, and limited community resources can turn discharge planning into hours of coordination.While these barriers are not clinical, they directly affect whether a resident can safely transition and remain stable in the community.DNG Health partners with healthcare teams to help coordinate these non-clinical factors through structured stabilization support, including housing navigation, transportation planning, benefits coordination, and connections to community resources.Our goal is simple: help residents leave care with the support they need to remain stable while helping care teams focus on clinical priorities. This approach supports continuity of care, helps reduce avoidable readmissions, and aligns with quality goals associated with value-based care models and CMS performance measures.
30 Days
Structured follow-up support during the critical transition period after discharge
92%
Stabilization Success Rate Across Coordinated Transitions
5+
Stabilization Domains Addressed:
Housing stability, transportation access, primary care engagement, benefits navigation, food security, hospital readmission prevention, and community resources
Why Facilities Partner With DNG Health
Are your case managers overwhelmed trying to coordinate resources for residents who are medically ready for discharge but still facing barriers outside of clinical care?Do social workers spend hours searching for housing options, transportation solutions, or community resources while balancing multiple residents and administrative responsibilities?Are discharge timelines delayed because residents simply need more support navigating life after leaving the facility? DNG Health exists to help relieve that pressure.Facilities partner with DNG Health because we understand the demands placed on care teams, and our role is simple; to provide additional support where it’s needed most.When facilities work with DNG Health, case managers and social workers gain a trusted partner who helps carry the weight of complex transitions so care teams can stay focused on the clinical needs of their residents.
Stabilization Coordinator
Supports residents transitioning from healthcare facilities back into the community by coordinating stabilization services and community resources.
Program Director
Oversees the Community Stabilization Program and ensures services are delivered effectively for healthcare partners. Focuses on program strategy, operational oversight, and partnership development.
Population Health Analyst
Supports program evaluation and outcome tracking across key stabilization domains. This role analyzes trends related to access to care, community resources, and social determinants that impact community transitions and overall population health.
Connect With DNG Health
DNG Health is committed to supporting healthcare organizations and community partners working to improve transitions from healthcare settings back into the community.If you would like to learn more about our stabilization program, partnership opportunities, or community initiatives, feel free to reach out through the contact form below.
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Thank you
A member of the DNG Health team will review your inquiry and follow up shortly to learn more about your organization and discuss potential partnership opportunities.We appreciate your interest in working with DNG Health to support community stability.