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04.21.16

5:00pm

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Chronic Care Management Boosts In-Home Care

Chronic Care Management Boosts In-Home Care

Receiving personal care in the privacy and comfort of home can be important for recuperating, chronically or terminally ill patients or persons with disabilities. In-home care facilitates independence and functional improvement. Home health patients receive medical, nursing, and/or therapeutic treatment through a wide range of health and social services. Receiving home health care reduces unavoidable readmissions, and studies have shown that patients recovering from injury, sickness, or surgical procedures heal more quickly and with fewer complications when recovering at home versus in a medical facility.

Hospice and palliative care management connect patients and advocates. Care coordination reinforces the care continuum for homebound patients and their caregivers.  Homebound patients may need assistance with daily living or medication adherence. Patients that can’t leave home because they require help from others or need a wheelchair or walker, or need special transportation or their condition restricts movement can benefit from care coordination. Homebound patients requiring, physical therapy, intermittent skilled nursing care, ongoing occupational therapy, or even speech-language pathology services can progress with TCM and CCM services.

Patients and family members serving as primary caregivers are often left alone to make difficult transitional care or chronic care management decisions. A clinical care team can work with providers and caregivers to deliver compassionate and personalized care in the convenience of patients’ homes. Home health care is more affordable than inpatient care and reduces the risk for infections.

Effective in-home care demands more efficient and timely interactions between patients and referring physicians. The right clinical care partner possesses qualifications that facilitate the overall goals of chronic care management. Partnering with NavCare to care for the chronically ill helps with home health requirements, comprehensive care planning, and electronic document exchange. Collaboration and communication among health care providers can deliver discharge planning, homecare intervention and patient education that improves disease management and self-care.

About the Author

Joseph F. West, ScD

Joseph F. West, ScD

Joseph F. West, ScD, is a population health and data analytics leader with over 10 years of research and enterprise consulting experience. He is a recognized leader in the development of outcomes-based healthcare. Joseph has served as Chief Population Health Officer, Senior Epidemiologist, Program Director, and Adjunct Assistant Professor. As a consultant and content creator, his current work focuses on population health management (PHM), health information technology (HIT), care coordination innovation, and healthcare risk management.

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