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Independence offers a Hospital Readmission Prevention Program that targets
members who have a primary or secondary diagnosis of heart failure (HF) or have
conditions that increase their risk of developing symptoms of HF. The program
helps patients learn self-care and aims to remove barriers to care. The
ultimate goal of the program is to reduce avoidable hospitalizations and
unnecessary utilization of both the emergency room/department (ER) and
observation services.
Based on our predictive model that includes clinical and sociodemographic
risk factors and medication history, we are able to identify members who are
likely to be readmitted to the hospital.
Independence is working with ReAdmission Solutions, LLC (RAS), an
independent, specialized company with a proven track record in patient
navigation, care coordination, and remote monitoring technology. RAS will work
with providers and their Independence patients on a multi-faceted advanced
disease management program that includes the following key components:
- scheduling and coordinating appointments and facilitating transportation
through community resources if available;
- continuous remote monitoring using advanced technology;
- home visits in accordance with the patient's home health benefit plan.
In addition, a RAS clinical coordinator is available 24 hours a day, 7 days a
week to answer questions for both patients and doctors. During their inpatient
stay, clinical coordinators may also be available to assist patients who have
been admitted to the hospital.
If you would like to refer a patient to the program, please contact RAS
directly at 1-800-533-3755. If you have questions or suggestions about
the program, please contact your network medical director.
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