Care Coordinators are registered nurses who are integral members of the Medical Home team. Care Coordinators work closely with physicians and patients to help navigate the system, assist with specialty referrals and proactively assist with different aspect of care. For example, if a diabetic patient hasn’t had important lab tests performed recently, or needs to follow up with other doctors to monitor the possible side effects associated with diabetes, care coordinators takes the lead in coordinating appointments, scheduling laboratory, assisting with referrals, tests and procedures. The information gained and the recommendations of other physician specialists become part of the communicated treatment plan coordinated by the physician-led Medical Home team.
Widely acknowledged as a vehicle for providing high quality medical care that proactively engages patients and their providers in a model of health that is coordinated and proactive, Medical Home is coming of age. CMC/ DHK continues to be a leader in New Hampshire and beyond, offering innovative health solutions that will help realize its shared goal of becoming the healthiest community in America.