Care Teams, Care Managers and Patient Referrals

Request: When Should a Care Team Refer a Patient to the Care Manager?

This question came from a practice quality support representative.

While visiting a number of sites, the representative noted the care teams were not clear in knowing which patients to refer to the care manager. When she asked the care managers, they had varied processes and triggers. She inquired about two areas:

  1. Tools to assist the team with referrals and
  2. Standards or guidance for enrollment into care management services.

Attached is a simple grid that your team or system might use as a starting place for referrals into care management. It was developed using health plan input and feedback from a Mi-CCSI facilitated workgroup that reviewed it.

This document does not contain all of the criteria you may ultimately need for referrals into care management. We invite your comments or suggestions on this template.

Patient Identification Template