Reduce high cost utilization

Care Transitions & Coordination

Care Transitions & CoordinationSM is an innovative service that reduces readmissions and avoidable, high cost utilization of hospital-based services by providing:

  1. Medical Home Network Development
  2. Care Coordination for patients needing help with connection to a medical home
  3. Care Management and transitions for the most at-risk, chronically ill patients
COPE Health Solutions has extensive experience implementing and managing this service and has successfully replicated the model at five hospital sites. A recent evaluation of Care Transitions & CoordinationSM conducted by external evaluators demonstrated over a 50% decrease in both emergency department visits and inpatient bed days for patients enrolled into the program.
 
To support this service, our team members become seamless extenders of the discharge process, utilizing your technology platform or a proprietary, web-based application that creates individualized care plans based on comprehensive assessments. We work with you to track patient compliance, create custom reports and efficiently manage large caseloads, while coordinating with community and hospital providers to develop comprehensive care plans.
 
Care Transitions & CoordinationSM is tiered to meet the diverse social and clinical needs of all patients and is effective for Medicaid, Medicare, Seniors & Persons with Disabilities (SPD), and other patient populations.

To learn more about Care Transitions & CoordinationSM or for more information about the Clinical Integration Solutions service line, please contact CIS@copehealthsolutions.org.

Reduce high cost utilization