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Care Management & Transition of Care
Reducing hospital readmissions through seamless care transitions.
Our care management and transition of care multidisciplinary model produces better health outcomes for patients while significantly reducing hospital re-admission and ER utilisation rates.
We target patients in facilities that would benefit most from care management and transition of care services. We utilise the expertise of our clinical pharmacists to provide medication reconciliation services as well as comprehensive medication discharge counseling that includes scheduled telephonic or in-person follow-up appointments within 24 to 48 hours post-discharge.
Detailed Services
01 Medication Reconciliation (MED REC) Services
Clinical pharmacists partner with patients, providers, primary pharmacies, and caregivers to create a complete, accurate, and current medication list.
02 Medication Discharge Counseling Services
Patients receive a thorough understanding of their discharge treatment regimen, with follow-up by phone or in person within 24–48 hours and again at 7 days post-discharge.
03 Prior Authorization (PA) Management Services
Full PA process management including submission, follow-up, appeals, peer-to-peer consultations, and patient assistance program enrolment.
04 Personal Care Assistance Services
Professional caregivers addressing non-medical or custodial care needs, homemaker services, and family-caregiver support.
05 Non-Emergency Medical Transportation Service
Transport to medical appointments and pharmacies, reducing transportation-related obstacles to care.
06 Patient Triage Services
Communication platform for non-urgent health and medication questions via phone or secure messaging, available after hours or post-discharge.