Clinical Corner: Promoting Patient Transitions of Care

Coordinating proper care through the U.S. health care delivery system is often a challenge due to fragmentation and segmentation. Health care barriers and silos need to be broken down and all health care providers need to work together as a collaborative team for the good of the patient. Through an efficient and patient-centered case management process, Alicare Medical Management excels at providing support to patients over an extended period of time and in a wide range of clinical settings.

Case managers must strive to provide smooth, seamless patient transitions. But this is not an easy task. Keeping the patient, family, caregivers, and the entire health care team, all in different settings, aware of the many steps and progress involved in the care of a patient is a major challenge.

Alicare Medical Management offers a unique blend of clinical and business services to support our case managers, attending providers, patients, health plans and others to ensure the highest clinical and financial outcomes. Managing transitions of care is part of our secret sauce. For example, we offer one-stop shopping for such interventions as case management, utilization management, disease management, nurse triage, readmission management and other programs through an integrated health information technology (IT) and workflow platform.

With so many aspects of care coordination to think about, case managers need to have a care management system that helps them assess, plan, implement, track, facilitate, and document key aspects of a patient’s care.

There is never a dull moment when managing a patient who has a range of co-morbidities. Promoting better transitions of care is like promoting higher quality; both are never ending journeys toward something better. Contact me if you want a few more case of examples why we are best-in-class when it comes to managing patient transitions of care.