Community Referral Coordinator Program

The Community Referral Coordinator Program utilizes Referral Coordinators to connect hospital patients from either the inpatient units or emergency room with a primary care provider for follow-up and preventive care. In particular, the program focuses on serving Medicaid and uninsured patients; however, works with all patients in need of a medical home. The program began in June 2007 and currently serves patients of BJC Barnes-Jewish Hospital, SSM St. Mary’s Health Center, Saint Louis University Hospital, SSM DePaul Health Center, Mercy Hospital St. Louis, and SSM St. Clare Health Center. The Referral Coordinators are employees of the IHN who work on-site in the hospital emergency departments and inpatient units.

Program Goals

  • Enhance access to a primary care home and health resources for all patients regardless of ability to pay
  • Reduce non-emergent use of emergency departments and low acuity readmissions
  • Enhance continuity of care
  • Strengthen communications/processes among safety net providers