The ICP Care Coordination Program has two distinct yet highly integrated services: the Transitional Case Management program and the Comprehensive Care Coordination program. These two innovative programs serve our patients and physicians with highly collaborative, effective, and evidence-based service coordination designed to improve patient outcomes and make the healthcare experience less complex and more satisfying for our patients. Our Care Coordination Team collaborates with patients and their primary care physicians to assist in coordination of care helping to demystify the complexities of the healthcare system. Our Care Coordination services span from assisting in transitioning from the hospital, providing support and guidance, researching community programs, and helping patients establish health care goals.
TRANSITIONAL CASE MANAGEMENT
- • Provided to hospitalized patients or those recently discharged from the hospital
- • Assist with the needs of ICP patients as they prepare to transition from an ICP network hospital or emergency department
- • Focus on maintaining clear communications between patients and family members, the primary care physician, specialist physicians, and post-acute facilities about treatment plans during and post hospitalizations
COMPREHENSIVE CARE COORDINATION
- • An intensive outpatient care coordination program using a specially trained care coordinator working with primary care physicians
- • Creates close relationships with medically complex patients and delivers highly individualized and accessible primary care
- • Develops a patient-centered, goal-orientated treatment plan and maintains close communication with the patient; supporting their efforts as they move to a more advanced state of emotional or physical wellness