Benedictine Health System (BHS), a Catholic, faith-based organization entrusted with advancing the life-enhancing senior care ministry of the Benedictine sisters of Duluth, Minnesota, has launched the Benedictine Concierge Care program as a three-month pilot to continue to support patients with their recuperation as they transition to home-based care. Benedictine’s initial site locations for the program include Benedictine Health Center at Innsbruck and St. Gertrude’s Health & Rehabilitation Center of Shakopee, Minnesota, both skilled nursing and rehabilitation facilities.
At discharge, patients (and their caregivers) who had been receiving inpatient treatment for chronic conditions including diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), chronic joint care (CJC), and infection, will be offered the opportunity to enroll in the Benedictine Concierge Care program that will extend the condition-specific support they had been receiving as inpatients following discharge.
As part of the initial enrollment, patients complete a health risk assessment (HRA) survey that confirms their condition, captures baseline health indicators and considers their self-admitted confidence level to follow their care plan post discharge, as well as circle of support. Leveraging GoMo Health’s sophisticated business rules engine, the feedback is scored, and each patient is assigned to an appropriate engagement track for the duration of the program.
Throughout the course of the program, patients receive content, resources and reminders to help them and their caregivers effectively manage their conditions at home. At the end of the program, each participant completes a conclusion survey to assess program effectiveness and impact.
The Benedictine Concierge Care program is designed to align with the new CMS Quality Strategy to improve care transitions and support as patients are discharged from a skilled nursing facility (SNF) to their home-based community of care. Providing innovative, timely education and reminders directly to patients and in support of their individual care plan, readmissions are reduced and recuperation improves, especially for high risk and senior populations.
“Benedictine has a keen focus on strategic review of analytics for predictive modeling and to promote and implement advance care plans,” stated Dr. Neal Buddensiek, BHS chief medical officer. “We focus on person-centered care programs that advance care planning, symptom management, and spiritual care. The Personal Concierge™ solution supports our effort, and the promise that we have made to deliver the finest care to our patients as they transition to home-based care.”
“Our unique Personal Concierge™ Readmission Reduction program is designed to support transitional care, from the point of discharge up to 90 days post,” stated Bob Gold, Behavioral Technologist and CEO of GoMo Health. “The program is based upon our exclusive BehavioralRx™ science, methodology, and communications techniques that leverage people’s innate behavioral and emotional attributes (such as trust, credibility and reciprocity) to drive real-time action.”
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