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Care Transitions Management - Benefits For Health Plans

Almost one-third of total healthcare spending comes from hospital stays – a large portion of which are readmissions. With the future of healthcare under constant scrutiny, it’s no wonder health plans are paying a large price for excess readmissions. Care transition management has never been more important.

The average hospital per admission cost in 2010 was over $15,000, and health plans are not only concerned about 30-day readmissions but all readmissions in general. While 20 percent of Medicare members are readmitted within 30 days, even more are readmitted within 90 days.

Avery Telehealth understands the best ways to prevent readmission. We do it through care transition management and a proprietary Readmission Avoidance Program (RAP). The program offers health plans both 30- and 90-day proven programs that coordinate with current health plans and guarantee savings to ensure a great member experience.


Wouldn’t you like to receive assurance of a certain outcome? At Avery Telehealth, we’re a health engagement companies with a promise like no other: we guarantee a 30 percent reduction in hospital readmissions. Period.

We do it through clear, customized communications, tailored resources and support for clients at every turn.


Knowing how to prevent readmissions means identifying what causes them in the first place. We know the greatest risk for readmission happens once the patient has left the hospital. The best discharge plans begin to unravel once the patient gets home.

Avery Telehealth can continue the care transition management with our exclusive Readmission Avoidance Program.


Overall Impact of the STAR Rating Improvement Program

With a total of 55 STAR Requirements, Avery Telehealth has obtained the following statistics:

  • In the drug sector: 6 out of the 18 requirements were met = 33 percent

  • In the health sector: 30 out of the 37 requirements were met = 81 percent

  • Empower and educate patient on how to care for their chronic disease.

  • Avery Telehealth nurse will answer questions related to chronic diseases and conditions.

“After assessing ‘build vs. buy’ options we chose Avery for their readmission reduction track record & savings guarantee.”

-Scott Cummings, CEO Care 1st Health Plan of AZ


Avery uses a proprietary care transition management system that takes the hospital discharge orders, executes the orders and proactively coordinates care with the patient’s primary care provider and other community health providers. All patients are remotely monitored by our nursing call center in Scottsdale, Arizona.

Through a combination of pre-discharge and post discharge procedures, Avery Telehealth has created a program that will reduce the amount of hospital readmissions.

  • Care Transition Planning: Converting discharge orders to care transition plans, medication reconciliation, care coordination, patient education and scheduling PCP follow-up.

  • Proactive Patient Centric Care Coordination: This step is crucial because it executes the care transition plan and ensures physicians are aware of their patient’s health status while providing medication compliance and patient education.

  • Remote Telehealth Monitoring: Allows us to track daily health status and vitals with the patient in addition to tracking symptoms and potential side effects to medications.