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Care Connections is a community-care team providing a temporary primary-care medical home for high-risk patients. As LG Health continues to focus on outcomes and avoiding preventable hospital readmissions, Care Connections is available for people with complex health and social needs, especially patients who are frequently hospitalized.

The Care Connections Team gathers before the graduation celebration in September.

On Sept. 12, the Penn Medicine Lancaster General Health Care Connections team celebrated 12 individuals who met their goals and completed the program.

“Goals can be anything from dancing at their daughter’s wedding to getting their blood glucose levels under control,” said John Wood, MD, LG Health Care Connections medical director. “This program is designed to fit the patient’s needs.”

The team, which includes physicians, advanced practice providers, patient care navigators, social workers, care management nurses, a behavioral health psychologist, a clinical pharmacist, a chaplain and a medical-legal attorney, strives to meet the needs of individuals who have been admitted to the hospital multiple times due to medical conditions and behavioral health challenges.

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