Transitional & House Call Models

Transitional & House Calls Model at SHC Medical Partners

SHC Medical Partners is a world-class medical provider organization bringing evidence-based and personalized patient centered care to those served – no matter where they reside.

Our Transitional & House Calls Model is focused on the coordination of care throughout the continuum assuring that quality and consistent evidence-based medical services at the point of care are delivered. Our team of medical providers work in collaboration with all disciplines at all levels of care to enable patients to transition and reside in the best setting and achieve their optimal health outcomes with independence and dignity. We provide a full spectrum of evidence-based medical service delivery including:

  • Primary care for adults and seniors
  • Transitional care management – first month post discharge service from the hospital or skilled/rehabilitation facility, including a 48 hour post discharge home visit with medication reconciliation
  • Medical house calls for acute and chronic illnesses
  • Providing the patients and families with the utmost comprehensive, collaborative and personalized medical care
  • Quality medical care in the comfort and privacy of the patient’s home
  • Utilization of EHR and data sharing with designated healthcare team
  • Medical care for those who have difficulty traveling to a physician’s office and/or clinic
  • Complex chronic care for patients that require highly complex medical care coordination for a longer term
  • Reduce unnecessary costly hospital, emergency room, physician office and clinic visits
  • Patient/caregiver education
  • Empowerment and support to patients to attain their highest level of function while living independently and with dignity