Case Study: Reducing Hospitalizations Through Continuous Clinical Care
How Integrated After-Hours Telehealth and Transitional Care Management Delivered Measurable Results for a Multi-State SNF Operator
Managing a complex resident population across multiple facilities is no small undertaking. For one multi-state skilled nursing facility (SNF) operator, limited overnight clinical coverage, fragmented transition workflows, and insufficient visibility into escalation patterns were driving avoidable hospitalizations and missed care opportunities.
Beginning in May 2025, Lumina Care deployed an integrated model, combining After-Hours Telehealth (AHTH) and Transitional Care Management (TCM) to address these challenges head-on.
The case study below details how we reduced hospitalization rates by treating 98% residents in place and taking over 2000 calls.
"Transitional care management has just been rolled out across the north region of New Jersey, and so far, the outcomes have been beneficial. The quality measure that gauges how well we're discharging our residents to the community has improved in a short period of time." —Robert Klimas, Vice President of Quality and Process Improvement at Complete Care Management
This is one example of how Lumina Care partners with post-acute providers to improve outcomes, reduce unnecessary hospitalizations, and strengthen care delivery across shifts and settings. To learn more about what this looks like in practice, explore our library of resources or browse our full suite of clinical programs.