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🤕 One wrong number is all it takes.   A patient in Michigan was hospitalized in July and ended up septic. Before going home, he spent some time in a skilled nursing facility.   Upon discharge, Crystal Lemos, RN, called to support the patient as a standard practice in Wellvana’s Foundational Care. Our nurses always ask about medication at times like these since changes in medication often lead to confusion.   This patient didn’t know what he was taking.   A few more questions revealed he also didn’t have any help at home. And he didn’t know if home health was coming to assist.   So Crystal traces back his steps through the health system. She discovers the SNF did order home health. But when she calls the home health agency, she learns that they couldn’t reach the patient, even after several attempts.   Just to be sure, she confirms that the agency has the same phone number for the patient that she has.   There’s the disconnect. Wrong number.   Without this kind of persistent support after hospitalizations, Medicare patients are more likely to wind up back in the hospital. Wellvana has seen a reduction in readmissions for practices who participate, on average removing approximately $1,200 in cost per patient from the healthcare system.    https://lnkd.in/eHyxBPvD

Our Approach to Curbing Readmissions

Our Approach to Curbing Readmissions

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