That is the whole model. Everything else is detail.
We deliver care and we prove it works
We deliver community health services and we generate the evidence that proves they work.
We do this alongside health systems, not instead of them. Community Care Connect extends the reach of clinical care into neighborhoods between visits. The Community Evidence Lab turns what we learn into knowledge that clinicians and health systems can act on. Together they build something that strengthens the whole system.
Community Care Connect
How we deliver care.
Community Care Connect is our direct service work.
Free cardiometabolic screenings. Blood pressure and blood sugar monitoring. Health education in plain language. Care coordination for participants who need help finding a doctor, understanding a diagnosis, or staying on a treatment plan.
It runs across 19+ sites in 10 Greater Boston neighborhoods. It is delivered by community health workers who live in the neighborhoods they serve, who speak the languages of the people they sit with, and who follow up because they know that one visit rarely changes anything.
Identification
We go where people already are: farmers markets, senior centers, community centers, houses of worship. We offer a free screening. We make it easy to say yes.
Active Monitoring
For participants with elevated readings, we schedule regular follow-up screenings. We track changes over time. We stay in contact between visits.
Behavior Change
Our health coaches work with participants on the daily habits that move numbers: nutrition, movement, medication adherence, stress. Not lectures. Conversations.
Maintenance
Participants who reach healthy targets stay connected. We check in. We celebrate progress. We catch backsliding early.
“What we've noticed when we get into communities is that we have people who are more curious about their health. They start with blood pressure. But then, after a conversation, they will have more questions.”
Bouba Diemé, Founder and Chief Inspiration Officer
Every participant who stays connected to a health coach is a patient who arrives at their next clinical appointment more informed, more engaged, and more likely to follow through. That is the value we add to every clinical relationship in the communities we serve.
The Community Evidence Lab
How we turn community knowledge into evidence.
The Community Evidence Lab is how we learn from what we do.
We track every screening, every follow-up, every referral, every outcome in Essyl, our bespoke HIPAA-compliant platform. We analyze patterns across sites and populations. We share findings with clinical researchers at Brigham and Women’s Hospital, Harvard Medical School, and beyond. We train community research trainees to participate in the knowledge-generation process, so that the people most affected by these findings have a hand in producing them.
The result is evidence that is rigorous and community-rooted. It comes from the community. It goes back to the community. And it reaches the decision-makers who can act on it at scale.
“HGF is filling a gap our system has never been designed to close. These aren't just screenings. They are sustained relationships between community members and trusted health advocates. The clinical outcomes are remarkable.”
Dr. Emefah Loccoh, MD, Cardiologist, Brigham and Women's Hospital, HGF Board Member
Find us across Greater Boston
We are rooted in Mattapan, Dorchester, and Roxbury. We work across East Boston, Hyde Park, Brockton, and beyond.
19+
Active sites across Greater Boston.
10
Neighborhoods served.
5
Community languages spoken by our health workers.
Most sites are walk-in. No appointment, no insurance, no referral needed.
This is community health infrastructure, built to grow.
Remote Patient Monitoring
For participants with the greatest need, launching in 2026, so that the care connection does not end between screening visits.
Earned Revenue Partnerships
With health systems and payers who recognize that community health workers strengthen clinical outcomes. We make their patients more engaged, their care plans more effective, and their communities more reachable. That is a clinical investment with a documented return.
Research Pipeline
Moving community-generated evidence from neighborhood screenings to peer-reviewed publication to policy.
Three ways to be part of this
Come in, partner with us, or help keep a health coach on a porch step this week.
Come get screened.
Free, confidential, no appointment needed at most sites.
