Concierge Care® 90-Day Readmission Reduction Solution

GoMo Health has tailored its Concierge Care^® solution to help reduce readmissions for the top causes and costs for hospitals and health plans.

The new GoMo Health Concierge Care 90-Day Readmission Reduction program, developed for initial launch for a visionary healthcare provider in the Baltimore, MD area, integrates the program on-boarding of inpatients within the current discharge workflow at the hospital, and provides continued mobile supervision by health plan Case Managers for 90 days.Initially, the program is being developed for disease states with the highest readmission rates and costs including diabetes, congestive heart failure (CHF), coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD) and upper respiratory infections. Several well-designed studies by the NIH have determined that relatively simple interventions can dramatically reduce the high hospital readmission rates for patients with COPD. For example, patient education, home visits and telephone follow-up have been shown to reduce hospital readmissions for exacerbations of COPD by nearly 40%. The GoMo Health Concierge Care program extends remote care management even further – customizing communications, resources and support for subscribers.

How it works

Patient onboarding to the 90-Day Readmission Reduction program begins as they complete a brief health risk assessment (HRA) survey on a secure wireless tablet or PC at point of discharge. Based on response, the program’s logic leverages evidence-based, custom-tailored protocols to stratify each subscriber into an engagement track which may include well care education, reminders to take and refill prescriptions, schedule and complete physical therapy and follow up provider appointments, and utilize local health care resources. This bi-directional content and feedback is captured in the GoMo Health platform, collecting real-time baseline and participant data on current heath and symptom indicators and measuring behavioral change through the course of the program, and allowing for detailed reporting and analytics.

The solution goes one step further by facilitating bi-weekly, secure 2-way SMS text chat conversations between patients and Case Managers to confirm recuperating status, provide non-emergency triage, and exchange information in real-time question and answer conversations. All conversations are captured digitally, with full reporting on participant activity available through the GoMo Health platform.

The program is available today in both English and/or Spanish, and can engage patients and care coordinators via mobile phone or email to accommodate the majority of today’s communications preferences.

For more information on GoMo Health’s Concierge Care suite of services, or to experience the program from the patient’s perspective, go to gomohealth.com/concierge-care.