POST-ACUTE CARE

Coordinate post-acute activities in real-time

As providers are increasingly responsible for preventing hospital readmissions, it has never been more important to ensure well-coordinated follow-up care.

Yet managing this beyond the four walls of your clinical setting is challenging and resource-intensive, requiring the coordination of patients, physicians, rehab specialists, home health workers, and many other disciplines.

Lumeon’s Care Pathway Management (CPM) platform enables providers to unite post acute teams around a shared, longitudinal pathway, showing care teams what activities should be performed next and tracking progress and outcomes in real-time.

Lumeon helps providers create pathways that span the 90-day follow up period, allocating care team resource and automated assistance, according to patient needs, so you can manage more patients, more effectively.

 

Key benefits:

Pathway library

Want to deploy quickly?
Take a look at our post-acute CJR pathway and others in our pathway blueprint library

Care plan coordination

The Lumeon CPM platform allows health systems to define and operationalize post-acute care plans, that can dynamically flex to the needs of each patient, utilizing phone calls, eQuestionnaires, and face-to-face appointments, to monitor recovery.

Unite care teams with a real-time view of patient progress, system-driven tasking and outcomes monitoring. The CPM platform ensures that home health, physical therapists, PCPs and community care nurses can easily share information and work together cohesively.

Alleviate task load for care navigators with intelligent care plan coordination, with a lighter-touch, virtual approach for low-risk, low acuity individuals.


A few features:

Remote monitoring and devices

Patient monitoring tends to be labor-intensive, especially where home visits are a common occurrence.

Implement monitoring regimes that absorb less resource, by adopting a risk-based care pathway approach. The Lumeon CPM platform allows providers to assign low-risk patients to pathways that direct digital review schedules, while frequent phone calls and in-person review are reserved for high-risk pathways.

Continuous patient monitoring through medical device integration is also possible, for example utilizing data from glucose meters to trigger appropriate care team intervention.


A few features:

Self-care

Before they leave hospital, patients are often expected to assimilate quite complex information about follow-up care.

Reduce confusion and reinforce patient education by assigning patients to automated follow-up programs that take the pressure off care teams.

The CPM platform enables providers to automatically send regular guidance on wound care, falls prevention, common problems to look out for, exercise regimes, and lifestyle changes. You can also leverage automated questionnaires to identify knowledge gaps, with additional virtual coaching or escalation to patient educators as required.


A few features:

Medicines management

Lumeon helps improve patients’ medication compliance, as well as ensuring timely titration, tapering, and review, in order to significantly reduce medicines waste.

By automatically interacting with patients using SMS or email, Lumeon helps ensure that prescriptions are filled appropriately, that patients complete the course, and that they follow a tapering regime as instructed, e.g. opioid or benzodiazepine tapering.

The CPM platform enables virtual management of medication dosage for low-risk patients using eQuestionnaires and digital conversations, while coordinating timely review schedules for higher risk patients, for example those who have been discharged after heart failure.


A few features: