From discharge to ongoing engagement.
Continuous outreach to your patient population to improve outcomes and reduce cost. Five touchpoints, one continuous thread — each handled by the right tier of care.
.png)
Your data, in your EHR — analyzed and routed for you.
Multiple engagement points across every line of care. Native dashboards let clinicians evaluate health data in their usual format.
How Telemetrix improved patient outcomes and care delivery.
Five sequential steps. Each is staffed by the right tier of care so the right person sees the right signal at the right time.
01Hospital / SNF discharge
Hospital / SNF discharge
Patient discharged with:
- CHF
- AMI
- Stroke
- Hip / Knee
- Other
02Post-discharge
Post-discharge
Four-week program: live call/text assistance, RPM setup, and assessment covering:
- Discharge instruction
- Medications
- Recovery
- Diagnosis questions
- Appointments
- Service / patient experience
Daily reviews of RPM readings and on-demand virtual visits.
03Triage
Triage
Tier 1
- TMX RN
- Virtual assist
Tier 2
- In-home visit
- Nurse Navigator EMT-B / EMT-P
04Physician consult
Physician consult
Tier 3
- Physical or hospital intervention
- Service or complex requirement
- Call, virtual visit, or appointment
05Follow up
Follow up
Transition to ongoing patient engagement:
- AWV (annual)
- CCM (monthly)
- Care plan management
- Care gap closure
- Preventative screening
- RPM (daily)
- Patient education & consultation
Want to walk this through with your team?
We'll show you the model end-to-end against your patient population.