One in four adults in the United States has multiple chronic conditions such as hypertension, heart disease, diabetes or asthma. Helping patients manage these chronic conditions is imperative in the reduction of  hospital readmissions and improving patient outcomes.  Augusta University Health is expanding its  patient-centered focus by partnering with NavCare, a comprehensive chronic care management program designed to assist patients with chronic conditions and  transitional care management services.

AU Health is a pioneer in Patient- and Family-Centered Care, and adding chronic care and transitional care management services is another way to equip patients and families with the tools they need to better understand their chronic condition and work to manage those conditions through an established plan of care. Specifically, NavCare specialists at AU Health will help patients:

• Manage conditions and medications with 24/7 access to experienced registered nurses.

• Identify and arrange needed services in the community, such as transportation, appointments, and home-based services.

• Monitor conditions and coordinate care with all of the patient's physicians and other specialists, including the lab and pharmacy, to keep them all connected and informed about the patient's care.

• Follow up after each doctor's appointment or when results are shared to answer any questions a patient may have.

"We chose NavCare because they are, first and foremost, a health care company with a team of certified clinicians," said Dr. Janis Coffin, Chief Transformation Officer for AU Health.  "They understand our patients' needs and can work with us to develop a system tailored to meet those unique needs, bringing the highest levels of consistency and quality to patient interactions. In addition, NavCare provides secure software that integrates with the electronic medical record to assure careful, coordination treatment and documentation."

NavCare provides a clinically certified team, combined with the expert providers at AU Health, to coordinate care. NavCare increases the ability of AU Health to see more patients by facilitating outreach and triage on behalf of those with chronic issues, using effective innovation and advancements that should enhance patient satisfaction, financial outcomes and provider workflow.