Services
Care Management Services
Compassionate High-Touch Care Management
Our licensed registered nurses specialize in managing complex cases, creating personalized care plans, and ensuring patients receive necessary support. We connect patients with social services to address social determinants of health.
Patient-Centered Education and Engagement
As an extension of your practice, we provide patient engagement support, emphasizing preventive care measures and enrollment information.
Chronic Care Management
Deliver comprehensive care coordination and support for patients with chronic conditions, enhancing their health outcomes and quality of life. Our chronic care management services prioritize patient well-being and high-risk care management.
Transitional Care Management
We help you facilitate smooth transitions between care settings, lowering readmissions and enhancing patient satisfaction through proactive post-discharge follow-up. Our commitment to transitional care management ensures seamless patient transitions and comprehensive discharge planning. We promptly follow up with discharged patients within 24-48 business hours to schedule post-care visits, offering extended support for 30 days to prevent readmissions and support high-risk care management.
Principal Care Management
Provide focused care for patients with a single, high-risk chronic condition, ensuring dedicated management and improved health outcomes. Our principal care management emphasizes personalized care and high-risk care management.
Behavioral Health Integration
Our approach to behavioral health integration enhances patient care and supports a comprehensive population health strategy. We help you integrate mental health services into primary care, promoting holistic treatment and improving overall patient well-being.
Remote Patient Monitoring
We support your efforts to monitor patients’ health remotely, enabling timely interventions and continuous care management for your practice. Our remote patient monitoring services not only enhance patient engagement but also support the use of data-driven analytics to improve quality of care.
