In the transition to value-based care, providers today are being asked to do something they are not use to—caring for patients outside of the clinical setting. With incentives aligned on reducing utilization and decreasing re admissions, providers must now focus on prevention and wellness, in addition to delivering quality acute care.
This task, however, of managing population health is easier said than done. Given the many social circumstances that impact an individual’s care, it is often difficult to ensure positive outcomes after discharge. Without active monitoring, providers can’t always guarantee patients follow the recommend care plan. And they can’t always verify that patients are being discharged to a place with suitable conditions for recovery.