You came home with a folder. Here’s the plan.
After a heart event, a cancer treatment, or a new diagnosis: the discharge instructions translated, the follow-ups on your calendar, and the rebuilding coached weekly. In Virginia, Clinical Care Navigation adds a nurse who explains what you were told, sequences the follow-ups, and walks you through your benefits.
Health coaching, self-pay from $79/week, in 14 states. Clinical Care Navigation, billed to your insurance, in Virginia. Coaching or clinical care? →
The first seven days, done right.
The week after discharge is when missed follow-ups and medication errors do the most damage. It’s the first thing we work on with you.
Usually it’s a son or a daughter who calls.They’ve been the coordinator since the discharge. Your coach helps with the rebuilding; in Virginia, your navigator explains the folder and sequences the follow-ups. Either way, the family can see the file.
After the first week: the checklist keeps going.
- Every specialist has every other specialist’s notes
- Rehab and tests on the calendar, in the right order
- One accountable plan of care, signed off by you
- Movement paced to where you actually are
- Food and sleep, worked weekly
- New medications taken the way they’re meant to be
- Follow-ups, meds, rehab progress, labs
- One-page summary to your specialists before the next round
- Diagnosis and treatment: your doctors
- The weekly session and the habits: your coach. In Virginia, understanding, scheduling and benefits: your navigator
- Showing up and being honest about it: you
Your coach, every week.
Getting the follow-ups and the paperwork done is half the job. The other half is rebuilding: movement, food, sleep, and taking the new medications the way they're meant to be taken. That's the weekly session.
The first week after discharge is when medication errors and missed follow-ups do the most damage. Getting that week right is the first thing we do.
Source: Forster et al., Annals of Internal Medicine, 2003.
Questions families ask us first.
Is this for family members managing a parent's care?
Yes. Many first calls are from a son or daughter. Your parent stays the patient; you can be on every call.
Is this the same as the case manager the hospital assigned?
No. Theirs ends at the hospital door. Yours starts there and follows you across every specialist, plan, and month.
What if the diagnosis is serious — cancer, heart failure?
That's who this program is for. We don't treat it; we make sure the people who do are working from one plan, and that nothing falls through between them.
Do you talk to my doctors or handle referrals?
Your coach works on nutrition, exercise, sleep and stress; clinical questions go to your own doctor. We don't file appeals or interfere with a specialist's decisions. In Virginia, Clinical Care Navigation adds a nurse who helps you understand your results and benefits and gets your appointments scheduled and sequenced.
Health coaching from $79 a week, self-pay. Clinical Care Navigation, billed to your insurance.
Coaching is available in 14 states and includes the weekly session and your dashboard. Navigation is a nurse-led clinical service available in Virginia; coverage varies by plan. Full pricing →
Five minutes with our intake team. Then you decide.
Bring the folder. If we're not the fit, we'll say so.