Peoples Health collaborates with Elara Caring on its Healing at Home Program, designed for Peoples Health members. The goal is to create an effective post-acute system of care that maximizes member experience—at no cost to the member—and improves quality of care and outcomes.
How the program works:
- Peoples Health patients being discharged from an inpatient stay can elect to be enrolled in the program and receive 60 days of at-home post-discharge care from an Elara Caring team of skilled nurses and therapists.
- An initial in-hospital visit may be conducted prior to discharge to perform a preliminary assessment and begin developing a plan for post-discharge care.
- Within 48 hours of discharge, the plan of care is completed and includes:
- In-home nursing and therapy services based on needs and chronic conditions
- Telehealth visits
- Telephonic outreach
- Home monitoring (blood pressure cuff, scale, etc.) if indicated
- The patient receives a thorough explanation of the goals for the discharge care from the Elara team, along with some printed materials.
- The patient’s primary care physician is kept informed about all care coordination efforts, including the need for follow-up care and medication adherence.