Taking Care of Patients At Home

Post Hospital Care – Post-Acute Care Program

After being in the hospital, many patients need a little more medical attention and hand-holding while they continue to recover at home. Post-Acute care is a free, in-home medical concierge service that brings doctors, nurse practitioners, nurses nad all other services to the comfort of your home. Once referred, we take care of our valued patients 24/7, 365 days a year.  Some of the services we offer in your home include:

• In Home Doctor and Nurse Practitioner Visits
• Home health nurse visits
• Pharmacist visit
• Social worker in home visit
• Comprehensive case management (Managing complex disease and conditions)
• Coordination of care (setting up doctor’s appointments, transportation, equipment and accessing community resources)
• Health education

What Is Medication Reconciliation?

As part of our services, we want to bring accessible medical services to our members living with chronic health conditions. Our team and health coaches will bring our care to the comfort of your home through house calls. Care plans are customized to each patient’s individual needs.

What Is Recovery Progress?

If you just need help making appointments, getting transportation, or understanding your insurance benefits, you can reach out to one of our care coordinators for help. We can provide those services for you over the phone, and even health management tools like blood pressure cuffs and weigh scales.

• Doing a full assessment of your health, including your social needs and community support
• Create a personalized health care plan with realistic goals to better manage your chronic disease
• Follow up to make sure your goals are being addressed
• Advocate for you during times of need