Our Care Model
Our Care Model
Our Care Model
REDEFINING MEDICAL DIRECTORSHIP WITH A COMPREHENSIVE APPROACH
Our Physician-led clinical pods create higher clinical standards for Post-Acute providers and improved outcomes for patients
Our Physician-led clinical pods create higher clinical standards for Post-Acute providers and improved outcomes for patients
GAPS Medical Director
- Extensive post-acute and executive healthcare experience
- Collaboration with primary care, hospitals, ACOs and Payers
- Subject matter experts in medication management, palliative care, hospice, managed care, nursing home and assisted living clinical services
Census Management
- Improving Hospital Partnership Channels
- Integrating patient care flow with ACOs
- Creating or supporting speciality programs to drive community provider relations
- Improve quality measures and elevate star ratings
PDPM Readiness
- Expertise in PDPM Documentation and Billing
- Physician driven rehab support
- Aiding in Coding Optimization -
- Mock PDPM review and preparation
- Ensuring appropriate PDPM patient classification and case mix documentation
GAPS Clinical Pharmacist
- Medication Optimization Management -eliminating unnecessary medications, adverse drug events and reducing unplanned hospitalizations
- Cost Containment - improving pharmacy efficiency and utilization
- Collaboration with nursing staff, physicians and GAPS Medical Director
Post-discharge After Care
- Continuous monitoring and after-hours coverage
- Identify and help manage clinical gaps and care needs during transitions from acute and post-acute settings and services
- Support for CMS -sponsored case management programs (AWV, CCM, TCM programs)
Physician oversight and communication
- Improving physician/nurse collaboration and communication pathways
- Ensure patients will be seen and examined in a timely/compliant manner
- Collaborate with physicians to improve patient outcomes
Patient and Family Experience
- Overly medicated patients don`t progress. Our appropriately treated patients SIMPLY FEEL BETTER
- Reducing unnecessary hospitalizations improves both patient and family experience
Quality Improvement and Advance Care Planning
- Ensuring all patients have appropriate advance care planning especially when there is change in condition
- Improve QAPI process and ensure regulatory compliance
ALF Care-Management
- We integrate our medical model into the existing social and community models enhancing the communities length of stay and improving patient outcomes
Patient-centric GAPS Clinical Model
Interested in a partnership with GAPS? Please contact us.
Contact Us
Interested in a partnership with GAPS? Please contact us.