Get On Board For Wellness

Care Coordination / Medical Home

Care coordinators are an integral part of helping patients and their families receive the best and most effective care possible. They act as a primary contact between our patients and community resources/agencies, specialists, and social services.

This is accomplished in a variety of ways.
  • First, they help track when and where our patients are referred for any health or social services outside of our practice, and help to make the process as smooth as possible.
  • Second, they will as much as possible follow up with patients within a few days of any emergency room visit, urgent care visit or hospital discharge. In this way, they can help arrange any needed follow up with both our providers as well as specialists.
  • Third, they will also assist our providers in communicating test results and plans of care with patients and their families. On the occasion that any questions arise during these discussions that cannot be answered by a care coordinator, a provider will contact the patient or family to discuss the situation further.
  • Lastly, a care coordinator will arrange for any home care our patients require and help to address any insurance coverage issues that may arise. This is especially helpful in caring for our patients with special health care needs.