Manage Gaps to Make Care Seamless

Supporting care transitions by identifying and helping to address clinical needs quickly and effectively.

Reduce Re-hospitalizations with Clinical Resources

Data That Drives Decisions

The Right Partner for Providers and Payers

GAPS Health

Reduce Re-hospitalizations with Clinical Resources
A Solution Built On Experience

Our 24/7 RN-led call center was built off the experience of serving one of the largest post-acute companies in the country. We understand the tenuous position of patients or members when transitioning from one acute or post-acute setting or service to another.

With clinical outbound, inbound, and after-hours capabilities, ​ we can quickly assess progress or decline and provide recommendations for services and/or solutions based on those assessments.

The key to smooth transitions is communication and the expertise of determining the right care at the right time and at the right cost for every individual patient or member.

Data That Drives Decisions
Where the Human Experience and Data Intelligence Come Together

With the experience of over 250,000 clinical interactions annually, we have developed the data intelligence and clinical best practices to guide patients through transitions and the journey towards health and recovery.

These interactions provide data points that we continually analyze. This allows us to assess the risks and requirements for every interaction and guide patients or members to the right care at the right ​ time and at the right cost.

The Right Partner for Providers and Payers
Customizable Solutions That Work

Every day we look for new and better ways to partner with health plans, health systems, provider groups and other strategic market partners to deliver innovative and ROI-proven solutions. Every partner has unique needs and is increasingly managing an evolving mix of fee-for-service and value-based objectives. ​ ​

But no matter the reimbursement models or incentives, patient engagement and effective care coordination are essential components for managing health and recovery. We offer an array of customizable solutions and the clinical expertise of an RN-led team to partner with a wide variety of providers and payers operating in fee-for-service and value-based reimbursement models. ​ ​

A small offering of the clinical gaps we identify and manage includes:

  • Primary care physician follow-up and appointment scheduling
  • Medication reconciliation and education
  • Falls risk and depression screen ​
  • Post-discharge site and services assessment (i.e. confirming if prescribed home health and/or durable medical equipment is scheduled and providing a quality service)
  • ED diversion/hospital readmission assessment (i.e. for declining patients we perform site of care assessment and make recommendations for appropriate level of service ​ ​

At University of Louisville Hospital, we wanted to give patients access to Lacuna Health's highly-trained clinical resources after discharge that we believed would optimize recovery and sustainability of long-term treatment and healing.

Paula Gisler,
Administrative Director
of The University of Louisville Hospital Stroke Center

GAPS Health
A New Model to Fill a Void in Skilled Nursing Facilities (SNFs) and Assisted Living Facilities (ALFs)

Lacuna partners with GAPS Health to help them implement an integrated care model consisting of the following four pillars: ​

  • Medical directorships
  • Pharmacy management
  • Chronic Care Management (CCM)
  • Post discharge program (AfterCare)

Lacuna couples its RN-led CCM and aftercare solutions with GAPS’ physician-led clinical model to help SNFs and ALFs optimize outcomes, improve compliance and maximize financial efficiency. ​

GAPS Health can
help your facility achieve operational excellence.

Reach out to us to reach your patients.

© 2022 Lacuna Health

© 2021 Lacuna Health