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Virtual Engagement with High Risk Patients


adds a layer of extra support for Skilled Home Health and Personal Care patients by providing personalized and interactive automated phone calls, paired with manual calls that assess for significant changes in health status and alert appropriate professionals to contact the patient.

Local clinical team members are alerted when a patient’s health status changes, allowing increased oversight even when we are not in the home.

Quick follow-up of alerts ensures interventions happen fast to reduce unnecessary hospitalizations.

  • Engage calls are set for the top 25% of Skilled Home Health patients identified as at risk for hospital readmission and for Personal Care Services caregivers in Indiana, Illinois, Massachusetts, Michigan, Missouri and New York.
  • Outbound calls include three to seven questions, some of which are targeted based on patient diagnoses. Any “yes” answer triggers a follow-up call and local clinical teams are notified for further intervention.
  • The Engage team ensures that any automated calls are conducted in conjunction with Skilled Home Health in-person visits, aiming to be performed on alternate days.
  • Personal Care calls are scheduled for each caregiver visit or can be completed by the caregiver on the mobile application before clocking-out.

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