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The iCare Follow to Home program arranges for skilled nurses to follow the member home after discharge from a hospital or Skilled Nursing Facility.

Follow to Home

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Follow to Home (F2H)

Question: When is a member at a high risk of being readmitted?

Answer: When the member has just been discharged.

The Follow to Home program does just as the program name implies: iCare coordinates with home health agency nurse case managers to follow the member home. They provide support and education to help the member and his/her friends and family better understand the strategies and techniques to avoid ending back up in the hospital.  

Key elements of the program include:

  • Readmission Risk Assessment (RRA) conducted upon discharge.
  • Home health agency RN call or visit as soon as possible post discharge when RRA score is high or medium.
  • Ongoing home visits and telephonic support are provided for 90 days.

The result: over the crucial next thirty days, approximately 90% of Follow to Home program participants are able to avoid re-admission.



Many commonalities exist between iCare and providers

We are both committed to improving community health and well-being with special attention to vulnerable, low-income populations.

To learn more about this and other iCare programs and how they can help us both reach our common goals:

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