Specialized Programs
Transition of Care
In our proactive and outcomes-driven approach to post-acute patient care, we aim to involve the right individuals at the right time and close the communication loop. We will notify primary care physicians following patient discharge, and coordinate a follow-up visit primary care office visit within three days of discharge.
Care Management
Our experienced care management nurses complete concurrent case reviews and monitor treatment plan adherence to ensure optimal patient outcome. We aim to ensure a seamless post-acute care experience, and eliminate complications and hospital readmission.
Disease Management
We are proud to offer disease management programs that are in line with the latest evidence-based practices, while being customizable by the provider as needed. Our disease management programs target the top reasons for hospital readmissions including Acute Myocardial Infarction, Heart Failure and Pneumonia.