• Care Transition
  Management
• Reduced
  Readmissions
• Chronic Care
  Management
• Bottomline
  Management

Care Coordination, Transition, Medical Records Management, Visibility into Care Plan

Building Value Based Partnerships

Bliss services are designed around your needs of care delivery across care-continum, even when patient is at home. Despite all good wishes, their is limited visibility into the care plan, delivery and the outcomes. Interventions are difficult and the patient invariably ends up in ER. The challenges mean lower quality care and higher costs, especially with such readmissions. The Bliss model means chronic cases are fully coordinated, driving down costs and readmissions. Each patient is assigned a personal Nurse Manager is assigned to you. She is local and always available to you for any assistance, questions or concern. Your patient forms a Care!Community- professional caregivers & volunteers based on their skills, temperament and other client's ratings whom you can assign activities for patient care. Then as care is delivered your organization gets to minute updates 24/7. You are always in loop proactively tracking the well being of that patient. Bliss supports you by coordinating all routine tasks like scheduling, medical records management, and issuing medication reminders. You can even request remote tele/video monitoring.

Smooth care transitions

Bliss ensures smooth, timely, and safe care transitions from the hospital to the home or skilled nursing facility. The Bliss Care Manager has an initial face-to-face visit with the patient while still hospitalized and visits the patients’ home after discharge. The Bliss Care Manager provides all recently hospitalized patients with the tools and support to promote self-management skills to understand and comply with their treatment plan and clinical care pathways. Bliss also provides patient and family education (including extensive on-line educational videos) about their condition

The Bliss clinical caregivers deliver the plan of care and ensure that all post-discharge activities such as medication reconciliation and follow-up doctors’ appointments are complete.

Timely, thorough communications are provided back to the hospital and all healthcare providers, including specialists.

Avoid preventable readmissions

Readmissions are a significant risk for hospitals in terms of financial exposure. Readmissions are generally more common for patients with chronic illness, at high risk for complications, age 50 and older, with multiple medications or recent readmissions.

Bliss is able to monitor the patient status in order manage the care and avoid unnecessary exacerbations of chronic illness that often lead to readmission. Working together with the patient’s physicians, Bliss is often able to intervene before a hospital readmission would be necessary.

State-of-the-art comprehensive patient data tracking and reporting available

All members of a Care Community including patients, families, and caregivers use the BlissCONNECT™ information system to access a 360-degree view of the patient. BlissCONNECT provides comprehensive patient data tracking on patient status, interventions, physician and testing follow up, therapies, etc.

BlissCONNECT™ engages patient, family, and community around care to ensure all patient needs (both medical and non-medical) are met.

With no system installation or costs, BlissCONNECT™ provides a single simple-to-use, intuitive portal for physicians, nurses, social workers, case managers, family, patients themselves, and volunteers to use to coordinate and manage care. ACO-directed system modifications can be done easily to processes and system.

Position for transition to accountable care organization status

Hospital and Physician Organizations will be under pressure to take on financial risk for population of patients. ACOs will need the ability to effectively manage their patients in the community to succeed in these reimbursement models

Bliss provides patient-centered, efficient care in the community coordinated with the patients’ doctors.

The Bliss clinical caregivers deliver the plan of care and acts as a liaison for collaboration among health care providers, patients and their caregivers.

Timely, thorough communications are provided back to the hospital and all healthcare providers, including specialists.

Bliss provides hospitals the clinical expertise, community resources, and information to successfully position themselves as an accountable care organization.