TRANSITIONAL CARE PROGRAM
Continuity of care is at the heart of MPAC’s Transitional Care Management (TCM) program. This program was designed on the premise that the Nurse Practitioner who cared for the patient at the facility is the best person to provide on-going high-level medical care for the patient as they transition from the facility to home.
The NP works in conjunction with a dedicated MPAC Care Manager to provide:
ASSESSMENT CALLS
Within two business days of discharge, the MPAC Healthcare Care manager calls the patient to assess the status of their transition
HOME VISITS
The Care Manager travels to the patient’s home and operates a HIPAA compliant Telehealth device that enables the Nurse Practitioner to perform virtual visits
24/7 Triage Line
If a patient is experiencing a change in condition, an MPAC Care Team member is available to help decide whether a trip to the emergency room is necessary
Is this Home Health?
There is an important distinction between home health care and MPAC's TCM program. The goal of home health is to provide nursing care, such as changing bandages and monitoring medications. Under the TCM program, the nurse practitioner will assess a patient's clinical stability, make adjustments to the treatment regimen, and write orders or prescriptions as needed.