Remcare Reduces Preventable Readmissions in Napa Valley

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Senior Helpers North Bay has successfully implemented Remcare’s Care Team Connect (CTC), a care coordination platform that improves transitions of care and reduces the number of preventable hospital readmissions, a critical tenet of healthcare reform. Senior Helper’s Community Care Initiative leverages CTC to improve patient outcomes through the delivery of cost-effective and well-coordinated medical care across the healthcare continuum.

Senior Helpers selected Care Team Connect (CTC) to support their growth in a post health reform environment. Senior Helpers North Bay’s Care Managers use CTC to more efficiently assemble and instantly distribute patient-specific and risk-driven care plans that outline what care is needed, when it is needed, and who is responsible for monitoring the plan in an effort to avoid preventable readmission to acute care facilities.

“About a year ago, Laura Jones, our nurse care manager, developed a program to provide care management to patients post discharge. In doing so, we realized an immediate reduction in readmissions for those patients receiving the service. In fact, our readmission rate was less than 5% for the same diagnosis across all chronic conditions,” observed Kevin Carlson, CFO, for Senior Helpers North Bay. “We knew then that we wanted to grow the program beyond our small pilot, and selected Remcare to partner with us to scale our efforts.”

Providers in the Napa community have real-time access to their patient’s care plans as they change, allowing for the delivery of effective and efficient care. Patients are assisted with obtaining appropriate primary and specialist care follow-up within 48-72 hours of hospital discharge and receive specific symptom management guides to their illness. In addition, CTC facilitates reconciliation and active medication management at discharge and throughout the duration of the care plan for each patient. To date, Senior Helpers North Bay identified medication issues in over 85% of their patients that they resolved before an adverse drug event (ADE) occurred.

“Senior Helpers North Bay was built with a commitment to improving patient outcomes, and the team at Remcare has been an incredible partner on this new offering. Their expertise in readmissions, understanding of clinical workflow and knowledge of program development has been instrumental in helping us achieve success with this new service line,” said Robert Nations, CEO for Senior Helpers North Bay.

Ben Albert, Remcare CEO notes, “We are very excited to partner with Senior Helpers North Bay to greatly improve care transitions in Napa Valley. The Care Team Connect platform combined with their highly skilled care management team is poised to do just that. We are privileged to be a part of it.”

About Remcare
Utilizing evidence-based best practices, Remcare creates technology platforms in which hospitals, community providers, family members and patients collaborate to improve outcomes in ways that can also reduce healthcare costs. By localizing how information and tasks are shared among care team members, Remcare creates transparency and accountability while also leading the way toward a patient-specific model of care. Easy to use and backed by extensive education, training and follow-up
support, Remcare solutions are designed to optimize healthcare performance throughout the continuum of care. To learn more, visit

About Senior Helpers
Senior Helpers navigates the Art of Aging by providing: Geriatric Care Evaluation – Sometimes families don’t know what they should do with their loved one. Our staff RN can now complete a FULL Geriatric Care Evaluation. Care Coordination – We have found that families are often confused about the services available in the community to help their loved ones. Care Coordination provides one of our professional staff members to arrange services. Wellness Watch – This program provides a weekly call to their loved one and a monthly visit. It also includes a LifeLine personal response system. Transitional Care – Our professional staff can act as a Transition Coach, meeting with the discharge staff, understanding the discharge plan and following up to make sure the discharge instructions are followed. In-Home Non-Medical Care – We will provide the best caregivers to help their family member remain in their home for as long as possible. Relocation Services – We can help find the perfect new home for your loved one. We will personally accompany family members on each visit and we will be by their side every step of the way.

Senior Helpers North Bay has three offices:

1100 Trancas Street         575 West College Avenue            802 B Street
Suite 214                            Suite 105                                         San Rafael, CA 94109
Napa, CA 94558                Santa Rosa, CA 95401                 Office: 415.460.9967
Office: 707.251.1540     Office: 707.525.1540                     Fax: 415.454.0540
Fax: 707.251.1582            Fax: 707.251.1582                    


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Carrie Kozlowski
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