The care management program facilitates communication and enables speedy recovery without stress on patients, families, or physicians. This is accomplished primarily through our Nurse Case Managers. Our case managers work directly with patients and their families to coordinate, plan, and transition medical care. They support the patient-physician relationship. Our nurses also monitor patients with chronic medical conditions through our Ambulatory Case Management Program.
Physicians DataTrust collaborates with our clients to mold a personalized care plan that exceed health plan standards. The task force identifies, monitors, and improves chronic disease symptoms and outbreaks through patient education. Together, we coordinate health care interventions for target populations to reduce costs and optimize resources. One resource we offer is our Homebound program, which further integrates patient needs and patient care. Our nurses visit noncompliant and homebound individuals to guarantee they are receiving the care they need and overall reduce ER admissions.
Our nurses work on-call and are accessible 24 hours a day to your members. Our hospitalists monitor all inpatient admits and communicate discharges to our care management department. Our Skilled Nursing Program (SNF) allows patients to spend less time in the hospital or even bypass an acute setting admission.
By utilizing our SNF program, we have significantly decreased inpatient expenses and utilization. Our dedicated SNFists closely monitor patient rehabilitation. Much like our hospitalist, SNFist create a rehabilitation plan and follow the patient through the care program. Our goal is to facilitate the healing process to get patients home quicker. Through these programs and other in house reporting, we monitor ER, inpatient, and ambulatory utilization to minimize over-usage and waste. By and large, our care management program improves patient quality of life, the overall healthcare experience, and continually explores cost-efficient alternatives.