The current American healthcare system is a confusing maze for many people. Too often, physicians and hospitals operate in silos and are at odds with health plans. Patients are left on their own to find specialists, schedule and keep appointments, and make important decisions about their care. For people with chronic illnesses such as diabetes, obesity and chronic obstructive pulmonary disease (COPD), navigating through the maze can be almost impossible. That is especially true when conditions are aggravated by mental illness. The result is missed physician appointments, failure to follow prescription drug regimens, and an over-reliance on hospital emergency rooms for routine care. This is not only unhealthy for patients, it’s also very wasteful—and it drives up healthcare costs for everyone.
That’s why we developed our Coordinated-Regional-Care model. Instead of working in isolation, our physicians, affiliated medical groups and hospitals collaborate closely and in partnership with health plans to give our patients and their families highly coordinated, personalized care. Whenever we enter a new market, we begin to implement our Coordinated-Regional-Care model. Our healthcare team works to ensure that people receive the right primary, specialty and follow-up care – when they really need it – in the most appropriate clinical setting, whether that’s a physician’s office, an outpatient clinic, a hospital or even a patient’s home. When people do require hospitalization, their care is coordinated throughout their stay and beyond– from admission to discharge to home and back to the primary care physician – so all they need to do is focus on getting better.
As part of this Coordinated-Regional-Care model, we dedicate networks of healthcare professionals to support our patients, especially the most vulnerable, outside the hospital and in cooperation with their health plan. This includes nurses and nurse practitioners who visit patients in their homes to evaluate their living conditions from a health perspective, provide clinical care and assist with activities of daily living. Since adverse prescription drug interactions are a major cause of hospitalization, we can also arrange for pharmacists to visit patients in their homes and help them with their medications. We can coordinate transportation for people to ensure that they make their follow-up appointments, and provide translators to assist patients in efforts to break down barriers to good health.
Coordinated-Regional-Care. The smart way to deliver care.