Goals of Care Coordination
At Memorial Regional Health, our Care Coordination team is here to:
- Enact early interventions to help prevent chronic health conditions
- Assist people with chronic conditions to better manage conditions for improved short-term and long-term health outcomes
- Support patients in addressing social needs that impact their physical and mental health
Don’t Know Where to Start?
Care Coordination Services
Care Coordination Programs
- Women’s Wellness Connection* – breast and cervical cancer screenings for low-income, uninsured and underinsured women
- WISEWOMAN (Well-Integrated Screening and Evaluation for Women Across the Nation)* – health coaching for women with chronic diseases (primarily diabetes, heart disease, hypertension, high BMI)
- Self-Monitored Blood Pressure Program – patients diagnosed with hypertension and/or with high blood pressure, short-term remote monitoring
- Weight Watchers – in association with the WISEWOMAN program
- Health goal-setting and coaching
- SNAP (Supplemental Nutrition Assistance Program)** – new applications and recertification assistance for people experiencing food insecurity
* Grant-funded program supported by Colorado Department of Public Health & Environment
** Grant-funded program supported by Hunger Free Colorado
Additional Care Initiatives
- Social Needs screening – follow-up, referrals, and coordination
- Chronic Care Management – Medicare patients only
- Medicare Annual Wellness Visits (MAWV) – Medicare patients only
- Annual Wellness Visits – all patients, insured and uninsured
- Patient Navigation – assistance to improve health outcomes, and reduce hospital readmission risk
