Clarify the care problem
Is the need primary care, wound care, post-discharge follow-up, skilled capacity, or coordination across several teams?
The Metro East Health model
Clinical ownership, skilled capacity, and communication—connected around the patient.
The model begins with a simple question: what would keep this patient from falling through the gap after referral or discharge?
How the model works
One intake, two audiences, one practical next-step process.
Review fit and setting
Location, current setting, urgency, existing clinicians, payer participation, licensure, and scheduling all shape the pathway.
Establish the next secure step
Intake confirms what information is needed, how records should move, and who should receive communication back.
Hospital and care-team problem
The patient’s PCP may be outside the network—but the clinical need is still inside the discharge plan.
Metro East Health is built to help when network boundaries, staffing limits, mobility, facility needs, or wound complexity make a standard referral insufficient.
- Primary-care relationship is outside the referring system or unclear
- Home or facility care needs exceed available local staffing
- Wound and chronic-condition needs cross multiple clinicians
- The referring team needs a practical update rather than a referral disappearing into a queue
Start with the right path
Start with the problem the patient and care team are trying to solve.
The intake team can then determine whether an available Metro East pathway fits and what should happen next.