The Community Referral Coordinator Program


The Community Referral Coordinator (CRC) program connects hospital patients in inpatient units or non-emergent emergency departments with a primary care provider for follow up and preventative care. The program focuses on serving underinsured, medicaid and uninsured patients, but works with all medically underserved patients to find a primary care home.


The CRC program focuses on transitioning patients from hospital-based care to out-patient primary care. CRCs work with patients who are already established with an IHN Community Health Center and patients with no Primary Care Provider who need to be connected to one, focusing on patients with chronic medical conditions

To read our Community Referral Coordinator program profile in the Healthy People 2020 sharing library go here.



Our vision is to foster collaborative healthcare systems where all community residents have full access to high quality, affordable, integrated healthcare.



Patient-centered. Driven by our mission, we commit to provide patients the support and education they need to make informed choices about their healthcare. We go above and beyond to help patients overcome barriers to accessing quality healthcare.


●      Payor Agnostic. We help patients navigate healthcare systems regardless of a patient’s payor status or ability to pay.


●      Social Determinants of Health. We ground our practice knowledge in the Social Determinants of Health because we understand that health outcomes are tied to patients’ economic and social well-being.


●      Trauma-Informed. We understand the adverse impacts that toxic stress and traumatic events have on the health of our patients.


Advocacy. We believe access to quality, affordable healthcare is a human right. We commit to respect and value the dignity of all patients we encounter. We will be an advocate within health systems for fair and equitable care for all patients.


Neutrality. CRCs are centered at the heart of healthcare systems to be neutral, third-party navigators within complex, and sometimes broken systems. We are not employed by healthcare providers in the system. Our neutrality helps to ensure that we put patients first during every patient encounter.


Using the CRC Program in your hospital

CRC’s are masters-prepared referral coordinators who serve as patient advocates and provider navigators. The program increases patient throughput and provides greater opportunity for shared best practices through the CRC Transitions of Care Task Force, leading to improved communication and coordination across health care organizations and with patients.

CRC’s currently see between 10-12 patients each day. Since 2007, the program has touched 70,000+ patient lives with 50% of those lives converted into a follow-up appointment, concluding in a readmission rate of between 2% and 15% (far below the national average).

Delivering health care has become much more complex over the years.  Hospitals now need to do more with less resources and less funding.  The Integrated Health Network’s Community Referral Coordinator (CRC) program works to:

-       Enhances access to a primary care home and health resources for all patients regardless of ability to pay;

-       Reduces low acuity readmissions and non-emergent use of emergency departments;

-       Successfully bridges the many conflicting initiatives with effective communications/processes among safety net providers; and

-       Improves overall continuity of care