Our Services Include:

Evaluation and Management

• Medical conditions
• Functional capability
• Behavioral problems
• Medications

Care Management

• Face-to-Face care management
• Tele-Care management
• Tele-Health biometric monitoring
• Collaboration with family
• Family and patient education
• Support of caregivers
• Home safety plan
• Medication reconciliation and visualization
• Fall prevention training
• Nutritional advice
• Depression counseling
• Palliative care support

Coordination and Coverage

• Coordination of care with physicians, health care providers, hospital discharge planners and health plan case managers
• Transitions from Hospital or Emergency Room to Home
• Care manager on-call 24 hours per day, 7 days per week

Risk Assessment

• MC3™ Risk Assessment
• VES13 Survey
• PRA Screening
• ICD9 Coding
• ICD10 Coding
• HCC Coding