At Cascala, we recognize that Primary Care Providers (PCPs) are the cornerstone of effective patient care, especially during critical care transitions. We’ve designed our Care Transitions Platform with PCPs in mind, ensuring that you have the tools and information you need to provide the best possible care for your patients.
Understanding PCP Challenges in Care Transitions
We know that as a PCP, you face unique challenges when managing patients through care transitions:
Lack of timely, actionable information about recent hospitalizations
Overwhelming amounts of discharge paperwork, often received late or incomplete
Difficulty coordinating follow-up care and medication reconciliation
Limited visibility into post-acute care plans and interventions
Challenges in meeting TCM billing requirements and deadlines
Balancing quality care with increasing administrative burdens
Pressure to drive quality and shared savings performance for your ACO
Bridging the Gap: Fostering Meaningful ACO-SNF Collaboration
Cascala’s platform is designed to address the key challenges in ACO-SNF partnerships:
ACO Primary Care Flex Model Participants
Get a clear, actionable overview of your patient's hospital stay within seconds
Focus on key clinical decisions without wading through unnecessary information
Tailored transition reports to augment the full patient record, discharge summary, etc.
Streamlined TCM Process
Embedded guidance for TCM visit scheduling and documentation
Automated reminders to ensure timely follow-up and maximize reimbursement
Support for meeting documentation requirements, optimizing coding and compliance
Enhanced Care Coordination
Gain visibility into post-acute care plans and interventions
Gain visibility into post-acute care plans and interventions
Reduce duplicate tests and streamline medication reconciliation
Actionable Risk-Insights
Receive prioritized lists of patient-specific risk factors
Focus your attention on patients with the highest risk of readmission
Real-Time Discharge Notifications
Receive immediate alerts when your patients are discharged
Proactively reach out to patients within the critical 48-hour TCM window
Cascala Empowers PCPs
Our Care Transitions Platform is designed to seamlessly integrate into your workflow, providing you with the right information at the right time:
Improve Patient Outcomes
Reduce readmissions and emergency department visits through better care coordination
Increase Efficiency
Save time with concise, actionable patient summaries and streamlined workflows
Optimize Revenue
Maximize TCM billing opportunities and improve performance in value-based care model
Enhance Care Quality
Make more informed decisions with comprehensive, timely patient information
Reduce Burnout
Decrease administrative burden and focus more on patient care
Stay Connected
Maintain a central role in your patients' care journeys, even during transitions
It's time to reimagine care transitions
While Cascala partners directly with ACOs and health plans, we’re committed to empowering PCPs like you to provide exceptional care during critical transitions. If you’re interested in learning how Cascala can support your practice through your ACO or health plan, encourage your organization to contact us for a demonstration.
