Referral Criteria

Who is appropriate for referral to Triad HealthCare Network (THN) Care Management?

Patients with:

  • THN Primary Care Provider
  • THN contracted payor (Traditional Medicare, Humana Medicare, United Healthcare Medicare, Cone Health UMR, HealthTeam Advantage)
  • HCC score 6 or greater, 2 or more hospitalizations in 6 months, 10 or more ED visits in one year
  • Targeted diagnoses: Heart Failure, COPD/Pneumonia, Hypertension, Diabetes, and/or Depression

Patients who:

  • Have a chronic health condition with daily management challenges
  • Have poor health literacy and/or problem solving skills
  • Have poly-pharmacy/medication barrier issues
  • Have family health education deficits
  • Lack social support
  • Are not safe to remain at home
  • Need referrals to community resources for social needs

To make a referral, please call 1-844-873-9947.