Remote Patient Monitoring

Remote patient monitoring (RPM) is used to help with post-acute patient stabilization and used for daily monitoring of disease conditions to detect exacerbation. RPM tracks patient conditions through biometric data, specific check-in data, and environmental sensors. With this health technology, Theoria Medical providers can quickly detect any changes in a patient’s vitals and step in to facilitate rapid intervention and reduce the risk of hospital readmission.

Our RPM device is lightweight, wireless, and battery-operated. It can be easily applied by patient or provider and is paired with a compatible relay tablet device that facilitates continuous real-time tracking of patient vitals. All patient data sharing is done in compliance with all applicable Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rule requirements.

At Theoria Medical, we understand that initiating, expanding, or integrating remote patient monitoring to manage chronic disease can be complex. It begins with understanding organizational strategic goals to facilitate strategic planning by both parties. As such, the Theoria Medical Implementation Team is highly experienced in strategic planning, program design, and ongoing program development to ensure the success of every remote patient monitoring program we put into place. For more information, connect with us.

Remote patient monitoring device

Our Services

Telemedicine

Value-based care requires telehealth. The health care field is quickly moving from fee-for-service to a value-based delivery system. Success in new payment models, such as bundling, accountable care organizations (ACOs) and new physician payment models, requires flexibility to deploy telehealth, particularly as part of care management programs. CMS has shown some willingness to provide waivers, and Congress has expanded the ability of some ACOs to use telehealth, but only in limited circumstances.

SPECIALTY CARE WITH TELEMEDICINE

Theoria Medical offers a host of specialty telemedicine services to contribute to the care continuum, reduce hospital readmissions, and optimize patient care. This includes virtual access to a provider at all times, including virtual treatment for substance abuse patients and immediate post-fall assessments via secure messaging, telephone, or telehealth video.

Doctor attending to a patient on a device

Pathways Program

INVESTING IN EDUCATION

Pathways include strategies to improve 30-day readmissions and address 90-day readmissions through strong collaboration between nursing and medical staff. This collaboration is critical to ensure success at a facility. For this reason, Theoria Medical invests heavily in educating the nursing staff upon implementation, and ongoing staff education thereafter.

Focusing on process improvement

We work closely with community partners to establish relationships with those involved in healthcare delivery relative to facilities:

  • Local health departments
  • QIOs
  • Clinical research organizations
  • Home health agencies
  • Hospice agencies
Research

Physician Services

The Theoria Medical model of care for post-acute care and skilled nursing facilities leverages a multidisciplinary approach to ensure optimal levels of patient care and outcomes. For this reason, we offer a host of medical specialty care services for patients living in a post-acute care or skilled nursing facility. These services are provided in the privacy and comfort of the patient’s room and transfers are not required to see a Theoria Medical provider specialist.

PSYCHIATRY

Weekly rounding by the psychiatry team. This team is comprised by a team of physicians, physician assistants, and nurse practitioners. Immediate interventions are available via telemedicine for behavioral issues that have occurred overnight -- this includes gradual dose reductions for all psychotropic medications to determine if symptoms, conditions, or risks can be managed by a lower dose. All medication reduction initiatives are performed in collaboration with an internal medicine specialist.

PHYSICAL MEDICINE AND REHABILITATION

Active management of PT/OT progression for acute-care and skilled nursing facility patients that are in alignment with key Accountable Care Organizations (ACOs) and other value-based networks key metrics:

Doctor and patient talking

Medical Directorship/On-Site Rounding

Comprehensive Medical Directorship

To ensure optimal healthcare delivery and a continuum of care, Theoria Medical orchestrates comprehensive oversight that include the following components:

  • Local health departments
  • QIOs
  • Clinical research organizations
  • Home health agencies
  • Hospice agencies

Stringent Medical Management with On-Site Rounding

Our comprehensive approach to medical management incorporates intensive clinical programs with health technology to ensure that our facility partners can manage complex patients -- allowing for admissions that may otherwise be denied. As such, highly trained medical professionals use the most up-to-date clinical guidelines for managing the health of a variety of patient populations.

Doctor attending to patient

Chronic Care Management

The Centers for Medicare & Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as a critical component of primary care that contributes to better health and care for individuals. Chronic care management includes any care provided by medical professionals to patients who have chronic diseases and conditions that last a year or more, requires ongoing medical attention, or limits the activities of daily life. It includes both physical and mental conditions.

The Theoria Medical Chronic Care Management Program (CCMP) leverages health technology and evidenced-based care management strategies to build customized programs with pre-determined outcomes and measurable treatment goals to reduce hospital readmissions and lower associated healthcare costs.

Research

Home Health Care

If you have home-based patients who have been newly diagnosed with a chronic condition or recently discharged and at risk of rehospitalization, consider adding health technology to their daily care regimen. Health technology includes remote patient monitoring for real time vital sign monitoring, electronic health records for automated documentation, and telemedicine to ensure that patients receive the right care at the right time -- allowing providers to adjust care management at any time.

Focusing on process improvement

We work closely with community partners to establish relationships with those involved in healthcare delivery relative to facilities:

  • Local health departments
  • QIOs
  • Clinical research organizations
  • Home health agencies
  • Hospice agencies
Doctor attending to patient

Electronic Health Records

Digital technologies have had a profound impact on addressing population health and improving the quality of healthcare delivery. It has impacted nearly every aspect of our daily lives and supports populations who may need care the most.

ChartEasy™ facilitates an organized structure across the care continuum by leveraging health technology with evidence-based patient care to improve patient outcomes. ChartEasy is a proprietary electronic health record (EHR) solution designed by Theoria Medical’s development team to review and document a patient visit.

Our proprietary technology facilitates a true continuity of care. The platform promotes digital inclusion through its sophisticated integrations with PointClickCare® and MatrixCare®, which are EHR systems used by many post-acute care and skilled nursing facilities today. The integration allows for real-time flow of information between systems to enable access to any updates on the patient’s status by care team members. It is designed to securely communicate patient records with primary care physicians, hospitals, and home healthcare agencies privy to the patient’s health records.

ChartEasy is designed to automate many of the processes that otherwise are completed manually and can be subject to inefficiencies that can result in sub-standard care. These processes include patient scheduling, medication reconciliation, and real-time connectivity between facilities to enable access to patients’ medical records and posting of progress notes to ensure accurate record keeping and sharing. Collectively, automation of these tasks can improve continuity of care. As the first physician group to develop our own proprietary EHR with in-house developers, we take pride in our team’s drive, commitment to excellence, and collaborative spirit.

ChartEasy