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Value to Healthcare Partners

The physicians and staff at our practice are skilled in collaborating with transitional care teams and population health management to achieve optimal patient outcomes. Always keeping the cost of care in mind, we understand the need for collecting outcome measures and regular communication as patients transition from hospital, to appropriate inpatient stays, to home.

Services include:

  • Engagement with Population Health and Transitional Care Teams
  • Ongoing direction and guidance of rehab and transitional care plans
  • Interaction with patients and families to help communicate the rehabilitation care plan and set expectations
  • We work closely with PT, OT, and SLP services to collaborate on patient care and attend rehab clinical and/or utilization review meetings to assist with care plans and discharge planning
  • Engage with primary care physicians and specialists to advocate for a facility‚Äôs best practices and promote appropriate utilization of post-acute inpatient options
  • Help support and strengthen relationships with skilled nursing facilities, bundled payment programs, transitional care teams and population health to improve patient care and overall satisfaction
  • Will assist with outcome measure data collection relevant to inpatient rehabilitative care