Senior/Geriatric primary care provided in clinics and mobile in senior communities.

AppleHealth works with Health Plans, IPA's and Hospitals to provide high-intensity outpatient care which breaks the cycle of preventable re-admissions and inappropriate ED utilizations. Re-admission rates for patients that are managed by AppleHealth are 5% compared to national re-admission rates of 21%. Patients with chronic medical problems that are managed by AppleHealth have 81% less inpatient admissions and ER visits. Transitional Care Services: Our program helps patients and their families transition through patient-centered education, medication reconciliation, assisting with follow up care, and continued care management at appropriate care settings to ensure preparedness of not only the individuals but also the Primary Care Provider for stable outpatient health management. This overall improves patient outcomes and prevent readmissions or return visits to the Emergency Department within 30-days or more of the time of discharge.Complex Care Management: Our program provides the necessary time, services, and resources to stabilize chronic medical problems then maintain that stabilization. Such services are provided to ambulatory patients in the clinic, homebound patients, patients in the SNF, Board & Care, Memory units, and Assisted Livings. Read more at www.applehealth.net

Developed a patient-centered coordinated care approach in between transitions of care that lead to a significant decrease of preventable hospital readmissions and unnecessary ED utilization; improvements in health outcomes; enhanced patient experience; and a reduction in total health care costs.