Our Model

We’re building partnerships to transform the future of health care.

Health care is changing. Policy makers are demanding better coordination of care to rein in costs. Inadequate care coordination resulted in as much as $45 billion worth of wasteful spending last year. Roughly 20% of all Medicare patients are readmitted to the hospital within 30 days of discharge, while chronically ill beneficiaries are 100 times more likely to have a preventable rehospitalization. Treatment of the most common chronic diseases costs more than $1 trillion annually and is projected to reach $6 trillion by 2050.

The creation of value-based reimbursement models is forcing acute care providers to rethink the importance of the post-acute care continuum on their bottom line. As application of these models expand from inpatient admissions to full episodes of care, including post-acute care and readmissions within a set time frame, hospitals must collaborate with stakeholders across the continuum to succeed.

Effectively engaging primary care physicians, post-acute care providers, and patients is a critical step in streamlining episodes of care and reducing the risk of readmissions. Given the number of stakeholders involved in a full episode of care, partnership management is rapidly emerging as the new core competency necessary for success under value-based reimbursement models.

Our partners rely on our expertise to guide them into the future of health care delivery.

We partner with healthcare systems of all types, from health insurance companies to multi-facility hospital systems to skilled nursing facilities and senior living centers. To stay competitive in this changing environment, our partners come to us to build a collaborative post-acute continuum of care focused on technology, efficiency, and performance.

Our partnerships are built on a solid foundation of accountability through an at-risk, shared savings model that ensures we don’t succeed until our partners succeed. We employ a multi-disciplinary, clinical-operational model focused on population management, physician alignment, and data integration which results in significantly improved financial performance, market share, rehospitalization trends, and quality outcomes.

Creating efficiency through performance and technology.

As the industry leader in technology utilization, our fully-integrated platform allows us to utilize electronic medical records, point-of-care documentation, tele-monitoring capabilities for physicians, providers, insurers, and family members. We can identify a patient’s risk of rehospitalization with an accuracy of 85%. Using an array of rich reporting tools, our clinical staff and operational management team have access to real-time data transparency. A seamless data exchange between providers allows for increased connectivity between physician and patient resulting in improved continuity of care and ease of coordination.

Our integrated care coordination model enables us to grow our partner agencies profitably and provide the highest level of patient satisfaction. We engage in a comprehensive assessment of our partners’ existing operations in order to personalize our post-acute management model to their needs. Once we’ve identified our partners’ specific needs, we work with them to establish accountability requirements and improve patient outcomes by coordinating care through a transitional care protocol. We educate the community, collaborating with physicians and nursing staff, as to the benefits of the appropriate use of post-acute care. On average, we’re able to increase the capture rate to our agencies by over 40% within the first year.

Finally, by leveraging our operational staffing infrastructure, our patients’ clinical outcomes are significantly improved through clinical pathways designed to deliver an outcome-oriented approach based upon their individualized plan of care. Our model has been ranked in the top 1% of operating models in the country. Packaged together, as a result our partners see an increase in revenue up to 35% within the first year and over 10% every year after while experiencing profitability exceeding national averages.