Care1: Post-Acute Care Management

Care Transition Services

The path to reducing Hospital Readmissions starts with the Transition of Patient Care.  The more attention paid to a smooth transition to the home or post-acute care providers after discharge, the better the chance that the Patient will recover and not visit the Hospital for a related readmission.

That’s why MD1 offers “High Touch” Care Transition Services with a focus on establishing and communicating a Post-Discharge Care Plan with both the Patient and his/her Primary Care Physician and Post-Acute Care Providers. 

MD1 will provide a Care Transition Coordinator to work directly with your facility’s Case Management personnel to insure a smooth Post-Discharge Transition.  We will establish a Care Plan for each Patient (with a focus on Patients with acute and chronic issues), assist with Referral Scheduling, manage the post-discharge instruction and self-management process, and facilitate provider-to-provider communications.  MD1 will even provide Patient Transport and in-home Functional Assessments as needed.

Check out our Care Transition Services, and contact us soon to discuss how Care1 can meet your specific needs.

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Care Management Services

Even after Care Transition Services have been properly provided, Hospital Readmissions can occur, especially with Patients who were previously admitted with acute or chronic issues.  That’s why MD1 offers a complete set of on-going Care Management Services to support Patient self-management efforts and to speed recovery without another Hospital visit. 

MD1’s Care Management Services start with a Patient Needs Assessments from a Mid-Level clinician that drives a Problem List and Treatment Goals. We then assist the Patient with Symptom and Medication self-management and provide Preventative Services as needed.  Our approach includes a 24x7x365 Call Center staffed with Clinical Specialists to interact with the Patient by phone as well as “High Touch” Care Management Services in the home and alongside Post-Acute Care Providers. 

MD1 will provide a Care Management Coordinator to work directly with the Patient’s Primary Care Physician and Post-Acute Care Providers, and will establish and manage direct contact with the Patient on a monthly basis at a minimum.  We will also provide relevant audio-visual clinical content accessible by the Patient to support self-management efforts.  All Care Management activity will be updated in the Care Plan for each Patient, and will be communicated with all clinical personnel associated with the Patient’s Care Plan.

Check out our Care Management Services, and contact us soon to discuss how Care1 can meet your specific needs.

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Care Coordination Services

If just about everyone has internet access, an email account, and a Tablet or a Mobile Device, then why can’t we exchange information on a Patient we both care for?  MD1 has a better way, and it’s called Care Coordination Services.

As part of our Care1 Solution, MD1 provides a Care Management Coordinator whose responsibility is to establish, update, and share a Care Plan for each Patient (with a focus on Patients with acute and chronic issues) with each and every authorized Clinician involved in the ongoing care of this Patient.  MD1 assists the Patient with Referral Scheduling, manages the post-discharge instruction and self-management process, and facilitates provider-to-provider communications through HIPAA-compliant secure messaging and data exchange.  We also offer a 24x7x365 Call Center and Website to facilitate immediate access to the Patient’s Care Plan and Encounter updates.

Check out our Care Coordination Services, and contact us soon to discuss how Care1 can meet your specific needs.

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