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Population Health Management

INSPINARY CareTeam 365 is a direct communication service partner to hospitals, Health Plans, Physician Practices. We offer patient monitoring, daily patient assessment and medication management via scheduled daily phone consultations to the patients. In today's value-based healthcare environment, where revenues depend on fast and effective identification and engagement of at-risk patients Inspinary Care Team 365 is the perfect solution.

In order to close the gaps in care, monitor patients' status and conduct targeted outreach without any sophisticated technology except a simple phone consultation. This is especially helpful for patients that are not techno savvy and majority have no smart phones either. Inspinary CareTeam 365 partners with our clients to offer direct patient communication 7 days a week 365 days of the year. All that a patient requires is a regular landline or a cell phone where our dedicated RN care coordinators, Nurse case managers and Pharmacist can reach out and perform phone assessments, guide, motivate, monitor the patient and identify potential health risks and report the findings to Care providers / Physicians' offices for timely intervention to avoid Emergency room visits and hospital readmissions.

Our offerings include the following:

HIGH RISK POPULATION CARE MANAGEMENT

Identifying at-risk patients and gaps in care


Preventive Care Program

LOW RISK POPULATION CARE MANAGEMENT

Preventive Care

In order to avoid hospital admissions it is essential to first collaborate with patients to prevent the unnecessary admissions. Waiting until a patient is admitted to realize he or she is high risk for readmission already puts care providers behind the curve



POST DISCHARGE CARE MANAGEMENT / Transitional Care program

Hospital Post-Discharge Management / Post-discharge outreach


Transitional care program: