Acute Needs Identified

A 23-year-old female with type 1 diabetes was transitioning from inpatient care to home with required daily wound changes that she was not able to manage herself. The member is unable to drive and has no support network. Additionally, the hospital social worker provided no discharge plan for transportation and the wound care clinic was not open on weekends.

Member Results

  • Reports improved level of knowledge and understands the resources available to her to manage her diabetes
  • No further in-patient readmissions or ER visits
  • Due to the PHN’s interventions, a potential readmission was averted
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How Conifer’s Personal Health Nurse (PHN) Helped
  • Provided education on basic diabetic self-care and coordinated daily home health care, which social worker did not know was available
  • Located ambulatory Type 1 diabetes adult support groups for member to attend once she is discharged
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Individualized Approach
Personal. Health. Nurse.

Help members navigate the care continuum to find the right care, in the right setting, at the right time —go beyond episodic case management or chronic disease management.

Our Personal Health Nurses engage members and optimize benefit plan utilization through collaborative care management and heightened health literacy.

Conifer Health’s Population Health Management solutions are powered by ConiferCore® technology, a proprietary platform for:

Member Advocacy

Care Navigation

Dedicated one-on-one collaboration and care planning with a Registered Nurse

Disease Management

Goal-based programs care for the person, not just the chronic condition

Case Management

Support members most at-risk for high-dollar or ineffective benefit utilization

Utilization Management

Maximize member access to the right care, in the right setting, at the right time

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