The Sutter Care Coordination Program (SCCP) is a patient-centered, case management program designed to help you manage your care by developing a customized plan to improve your health and quality of life. The program is built upon the collaborative efforts of patients, caregivers, the SCCP team and care providers (doctors) to improve patient well-being.

SCCP was the first program of its kind to receive Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Disease-Specific Certification.

How SCCP Works

The SCCP team is comprised of RN Case Managers, Clinical Pharmacists, Licensed Clinical Social Workers and Health Care Coordinators. SCCP staff are housed in the care centers and will work with you both in person as well as by telephone. You must have a Sutter Primary Care provider within Sutter Medical Group, Sutter Gould Medical Group and Sutter Independent Providers to be eligible for the SCCP program.

Available Services

The SCCP team works with patients who can benefit from additional support to improve self-management of their medical conditions. Services include:

• Transitions of Care — SCCP provides support to help you and your caregiver(s) get the care and information you need when leaving the hospital.
• Complex Care — SCCP works directly with you and your doctors to achieve ideal physical and mental well-being.
• Complex Medication Management — SCCP provides you with education and information regarding your medications.
• Mental Health — SCCP Social Workers support your mental health needs and can assist you in accessing community resources.

Program Benefits

If you are trying to manage a chronic illness, have limited caregiving support or have experienced a recent hospitalization or emergency visit, this program can address your needs.

• A support system; an advocate for your health.
• Coordination of care with primary doctors and specialists.
• Filling in the gaps and assisting with a smooth transition from hospital/short-term rehabilitation to home.
• Disease monitoring to identify early signs/symptoms that might indicate your condition is worsening.
• Preventing unnecessary urgent care and emergency department visits or readmissions.
• Providing available resources (for example, community resources, transportation, home care, medication costs and more).