Care Coordination - Our Goal for You at York Medical Clinic
Care Coordination serves to connect you with your Primary Care Physician to make sure all your questions are answered and you are able to participate and understand your medical information.
Our goal is to help you have better access, and high quality care while controlling healthcare costs.
What is Care Coordination?
York Medical Clinic has invested in your healthcare by staffing nurses who can assist you in overall medical communication, coordination assistance and referral for services, and preventative health consultation.
How do Coordinators know who to help?
Our referral for assistance come from inpatient stays, physician referrals, patient requests, ER Visits, healthcare data or family members and caregivers.
Why don’t I just talk to my doctor’s nurse?
The physician’s nurses are always available. However their main priority is the assistance with clinic visits and the follow up and coordination of day to day clinic visits. Care Coordination serves a broader spectrum of all healthcare coordination beyond just the clinic visit.
Transition to Home after Inpatient Stay or Emergency Room
When you go to a hospital or ER our Coordinators receive information from the facility. You should expect a call from one of our Coordinators within 2 days of your discharge from inpatient and within 7 days of an Emergency Room visit.
Our goal is to assure medication changes are made to your medical record, update your physician on your status, assist with follow up appointments and provide overall teaching and coordination of any additional help you need. This may include referral for home health, community services, home equipment or assisting with high cost medications.
Chronic Care Management
If ongoing chronic healthcare is difficult to manage for patients and their families, our Care Coordinators can provide short or long term oversight of patient’s overall healthcare. This is done via regular phone calls, in-home visits, follow up of specialty services, joint physician visits and help with scheduling.
In an effort to keep our patients healthy, our Coordinators regularly review charts to assure preventative testing like mammograms, colonoscopy, PAP, blood pressure checks and lab work are current. Staff also review immunization records, and diabetic testing for proper follow up. You may receive phone calls or portal message from coordinators to remind you of these important schedules.
Our diabetic teams, led by our licensed diabetic educator, provide the most current education for proper nutrition and medical management of your diabetes. She can also meet 1:1 for chronic care management of each individual patient needs.
York Medical Clinic strives to engage all patients in their own personal health, but also overall patient satisfaction. Regular Patient Engagement Panel meetings are held quarterly.
Participation in Patient Portal, and e-Visits are also options for patient engagement.
Sherri Rediger RN, BSN
Director of Care Coordination
Jenn West, LPN
Charlene Dorcey, RD,CDE, LMNT
Patient Engagement & Community Health Liaison