Start the handoff
Bring discharge information and contact responsibilities into the workflow.
Transitional Care ManagementCurrent workflows
Make the next step after discharge clearer.
Coordinate the contacts, appointments and open questions that follow a transition home.
TCM
After discharge
AMANA HEALTH COLLECTIVE
The practical output
A discharge follow-up record covering contact and appointment status.
- Software · Current workflows
- Transition Care workflows and TCM reporting.
- Navigation support
- Discharge outreach and appointment coordination.
- Before launch
- Discharge information and time-sensitive clinical follow-up ownership.
Who it helps
Transitional Care Management in practice.
Patients returning to the community after a qualifying care-setting discharge who need a coordinated transition.
Connect with the patient
Support outreach and help arrange the required follow-up with the clinical team.
Track what remains
Document contact attempts, appointment status and issues requiring clinician attention.
Clear responsibilitiesConnected work.
Your clinical team Amana support
Connected work.
Defined clinical roles.
Clinical direction.
Performs the required clinical visit, medication reconciliation and clinical decision-making.
Practical follow-through.
Coordinates outreach, appointments and documented follow-through within the agreed transition process.
The engagement defines staffing, supervision, service availability and responsibilities before work begins. Navigators work within the care plan. Diagnosis, prescribing and treatment changes stay with qualified clinicians.
The software connectionGive the work
Give the work
a shared home.
Transition Care workflows and TCM reports make discharge, outreach and appointment activity visible.
Explore the Amana platformWhat we clarify before launch.
- Reliable discharge information
- Named clinical follow-up owner
- Time-sensitive outreach and escalation process
Explore related support
Care needs connect.
Explore adjacent programs. We review clinical fit and service requirements when programs are combined.
Let’s shape your TCM workflow.
We’ll review the patient population, clinical responsibilities and support your team needs.