Care Coordination

KVH’s care coordination team was developed as part of national health care reform efforts to improve patient care. The care coordinators work with providers, complementing and extending care by working with patients who have been identified as potentially needing additional attention and services outside their practitioner’s office.

Care coordinators focus on what happens with patients between their visits to their provider. There is only so much a provider can do during a 20-minute office visit, and good health outcomes were often dependent on everything going exactly as the provider planned after each visit.

The problem is all too often patients face obstacles or challenges that prevent them from following their providers’ advice or instructions. The goal of care coordinators is to connect with those patients most likely to face such challenges and help overcome them. Now, when KVH providers identify patients who could benefit from follow-up communication or assistance, they alert their care coordinator, who connects with the individual, assesses his/her or needs and provides any guidance or assistance necessary.

Promoting a Smooth Transition

Our goal is to assure you have the care you need once you leave the hospital or clinic. We draw from in-home, community and family resources to help you or your loved one return to as independent and productive a role as possible. This planning can begin even before hospital admission, or following diagnosis in our clinic.

We coordinate patient and family needs with a variety of resources, including:

  • Home health agencies
  • Skilled nursing facilities
  • Public health departments
  • Meal services
  • Medical equipment supply companies
  • Social services
  • Medicare/Medicaid regulations
  • Financial assistance
  • Alternative living arrangements (such as residential care homes)
  • Rehabilitation centers
  • Hospice care
  • Respite care
  • Transportation resources
  • Medicare annual wellness visits
  • Medicare Advanced Care Planning

Office hours are 8 a.m. to 4:30 p.m., Monday through Friday.

How to Reach Us

  • Jane Dyment, RN (Medicare Specialist) 509-772-2613
  • Gail Garcia, MA-C (Medicaid Specialist) 509-773-1018

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