Chronic Care Management with Remote Patient Monitoring
Our chronic care management gives you more personalized care, beyond home traditional health. You get live access to healthcare professionals’ 24 hours a day 7 days a week. Care is coordinated with your doctor and if necessary, we will supply medical devices and train you on their proper use, so we can monitor your health daily. Our goal is to help you heal better in the comfort and safety of your home.
The suite of programs working in combination with the primary objective to safely transitions high-risk patients from an acute or post-acute setting to home, preventing unnecessary rehospitalization by consistently delivering improved patient outcomes and reduced cost of care among high-risk patients through our disease management model provide a set of proven interventions and goals to promote positive outcomes.
Disease Management
The VNA clinical pathways have proven methodology to educate patients with chronic illnesses and their families on critical aspects of the disease process. Self-care protocols empower individuals to manage their disease process and prevent declining health complications, guiding the patient to reach their optimum wellness and functional capability level.
Transitional Care Model
The comprehensive goal is to safely transition high-risk patients from an acute or post-acute setting to home, preventing unnecessary rehospitalization by delivering improved patient outcomes driving cost containment among complex patients through disease management protocols, interventions, and goals to promote positive results.
Medication Reconciliation
The principles align with the fundamental prescription drug compliance guidelines of the Joint Commission. They incorporate patient Education, Engagement, and Empowerment on the proper use and knowledge of medications and over-the-counter adverse effects adherence, all driving 30day readmission mitigation.