better care for a better
quality of life
CareAlly provides guidance and support to people with serious illness.
The Solution
Patient
Receive the right care, aligned with their values and goals
Provider
Are supported in delivering higher-quality care, improving outcomes and increasing patient satisfaction
Payer
Improved quality and communication for complex patients. Less hospitalizations and cost
CareAlly offers Providers a low-cost, virtual serious illness solution:
- Dynamic risk stratification of patients to tailor services to needs
- Real-time notification of ED and Hospital admission/discharge for immediate response
- 24/7 after-hours clinical triage and support
- Patient/Caregiver/Family always have a CareAlly available for guidance and support
- CareAlly staff coordinate directly with the patient’s existing medical team
- Combining the expertise of Palliative Care with longitudinal Care Management
- Experienced palliative care nurses and social workers who are also care management trained/certified
- Individualized and dynamic care plans made collaboratively with the patient
- Complex Care Guidance for patient/family by consistent CareAlly staff
- Expert communication skills for 1:1 and family discussions
- Care coordination across the continuum to ensure smooth care transitions
- Chronic Care Management and Principle Care Management Services
- Medication reconciliation and education regarding each prescription
- Routine, proactive symptom assessment to avert crisis
- Disease self-management training and support
- Family/Caregiver assessment and support
- Clinical interventions to promote healthy coping and adjustment
- Every interaction focused on aligning patient’s values, priorities and goals with their treatment
- Advance care planning is an ongoing, relational collaboration to help the patient/surrogate discover what quality of life means to them
- Cultural humility, respect and active listening results in goal concordant care
- Assistance with advance care planning documents to reflect their goals
- Communication of patient wishes for treatment with entire care team
- Care coordination across the continuum to ensure smooth care transitions
- Chronic Care Management and Principle Care Management Services
- Medication reconciliation and education regarding each prescription
- Routine, proactive symptom assessment to avert crisis
- Disease self-management training and support
- Family/Caregiver assessment and support
- Clinical interventions to promote healthy coping and adjustment
- Social Determinates of Health Focus to ensure lack of resources does not result in health inequities
- Screening
- Assessment
- Connecting to local resources
- Follow up
- Removal of Barriers to Access
- Extensive and continual training of staff to ensure respect, knowledge and skills to ensure inclusivity for underserved communities
- Specialty services available anywhere with virtual and/or phone services
- Focus on rural health needs – not reliant on internet connectivity for services
- Health technology navigation for patient’s other medical provider appointments/access to patient portals
" I like to tell my patients that the health care system is like a giant conveyor belt carrying you along with “evidence-based guidelines” and “standard practice”. People feel pushed and prodded, confused and stressed by a system that doesn’t listen well. My role is to get to know you as a person and understand what makes you, well you. What brings you joy and meaning and purpose? What causes pain and stress? Once I understand you, then we can talk about how to give you more joy in life and time with those you love. And I think that is the purpose of CareAlly. "
– John Morris, MD
Chief Medical Officer/Co-Founder
Goal concordant care equates to high quality and high value care
- Care at home whenever possible
- Anticipatory guidance, based on patient goals of care, prepares patient/family for focused and efficient medical appointments to solidify treatment plans
- Advance care planning discussions and documents guide any future hospitalization
- Appropriate utilization of post-acute services
- Timely Hospice referrals and utilization when appropriate