The benefit of this telephonic management program to your patient will be that they are provided resources, disease, and medication monitoring, education, and will have a patient-focused plan of care.

Higher acuity patients will benefit from this program because they have an acute level and will require a higher level of telephonic management. These patients will be provided with resources, education, disease management, medication management, and a patient-focused plan of care as these patients are at higher risk of hospitalization and require moderate to higher levels of medical decision making and will be provided more telephonic Case Management.

After being recently discharged from a hospital or skilled facility, our Case Managers will ensure that the patient has proper medications, understands discharge instructions, and is provided with education and resources to prevent rehospitalizations or ER visits. The Case Manager will work directly with the physician’s office to schedule and encourage follow up appointments within 14 days of discharge.

These patients have been recently discharged from a hospital or skilled facility and have multiple complex disease processes. Our Case Managers will ensure that the patient has proper medications, understands discharge instructions, and is provided with education and resources to prevent rehospitalizations or ER visits. The Case Managers will work directly with the physician’s office to schedule and encourage follow up appointment within 7 days of discharge.

Additional benefits to the CCM or TCM Programs may also have Behavioral Health Integration. This program is for patients that have any mental health, behavioral health, or psychiatric condition, including substance use disorders. The Case Managers will provide not only the health management aspect but will assist with resources, guidance, and education on their mental health needs.

With the Principle Care Management program, patients are not at high risk for hospitalization due to their disease process. They will be provided telephonic Case Management for resources, education, medication, and disease management to assist them with maintaining improved health and overall well being. These patients will also be provided with a patient-focused plan of care.