Personalized respiratory solutions across the care continuum.

Population Outcomes Management (POM)

Helping Members Better Manage Chronic Respiratory Conditions

Our Population Outcomes Management program supports members living with acute and chronic respiratory illness through personalized education, ongoing clinical engagement, telehealth, in-home support, and care coordination.

By identifying changes early and providing proactive interventions, we help members stay healthier, avoid unnecessary emergency department visits, and better manage their respiratory health.

Program highlights

• 62% reduction in hospital occurrence
• Personalized respiratory care delivered through telehealth and in-home support
• 24/7 access to Respiratory Therapists
• Care coordination across providers and care teams
• Member education that encourages confidence and self-management
• Early intervention to reduce hospitalizations and emergency department utilization

Conditions supported

• COPD
• Asthma
• Obstructive Sleep Apnea
• Acute or chronic respiratory failure

Complex Respiratory Management (CRM)

Specialized Support for Members with Advanced Respiratory Needs

Support to members post POM graduation, opted out, or does not qualify for POM. Members include both invasive and noninvasive mechanical ventilation, tracheostomized members as well as Complex Respiratory members in the home setting.

The program allows earlier intervention and slows disease progression. Provides support as an alternative to Hospital/ED admission and a sense of security for the member at any time.

Program highlights

• Monthly wellness calls and quarterly assessments to monitor for any status changes
• Caregiver education and reinforcement
• Ventilator weaning support
• Collaboration with home health and DME providers
• Transition-of-care support
• 24/7 Respiratory Therapist guidance for members and caregivers

Who we support

• Members using mechanical ventilation
• People living with a tracheostomy
• Members with other complex respiratory conditions
• Members transitioning from intensive support

Enhanced Respiratory Care

Improving Respiratory Care in Skilled Nursing Facilities

Our Enhanced Respiratory Care program provides delegated utilization management and respiratory oversight for mechanically ventilated and tracheostomized members discharging from the acute-care setting to the Skilled Nursing Facilities (SNF) or to the Long Term Acute Care Hospital (LTACH).

Working alongside facility leadership and care teams, our respiratory clinicians help improve care quality, support ventilator weaning, facilitate safe transitions, and ensure members receive the most appropriate level of care.

Program highlights

• Respiratory quality oversight
• Outcomes-focused interventions supporting ventilator weaning and decannulation
• Transition support from acute care and LTACH settings
• Reduced hospital bounce-backs
• Ongoing quality monitoring and collaboration with facility teams

Quality Enhancement Initiative

Supporting Continuous Quality Improvement

The Quality Enhancement Initiative partners with Skilled Nursing Facilities to strengthen clinical quality through collaboration, education, and performance improvement.

Dedicated clinical liaisons work closely with facility leadership to identify opportunities for improvement while providing ongoing education, quality monitoring, and performance reporting.

Program highlights

• Dedicated facility liaisons
• Clinical education and staff support
• Quality metric improvement
• Resident satisfaction initiatives
• End-of-life care planning support
• Monthly engagement and quarterly reporting

Remote Patient Monitoring

Connected Care That Supports Earlier Intervention

Our Remote Patient Monitoring program allows clinicians to identify changes in respiratory status earlier, enabling timely interventions that can improve outcomes and reduce avoidable utilization.

Remote monitoring includes

• Oxygen saturation
• Pulse rate
• End tidal CO₂ monitoring
• Trend analysis and early clinical alerts

When incorporated into care plans for high-utilization members, remote monitoring has demonstrated meaningful reductions in utilization while supporting safer ventilator and tracheostomy weaning.

Tennessee Katie Beckett Program

Specialized Respiratory Support for Children with Complex Medical Needs

Katie Beckett Program (KBP) – Tennessee's Katie Beckett Program was launched in 2021 and is focused on our Pediatric community, age 18 or younger, with disabilities and/or complex medical needs who qualify for the Medicaid Waiver. We work cohesively with TennCare and Blue Cross Blue Shield of Tennessee to assist Group A members in the program identified with compromised respiratory needs.

Working alongside families, caregivers, providers, and care teams, our Respiratory Therapists provide education, respiratory assessments, care coordination, and ongoing clinical support that helps children safely receive care at home whenever possible.

Program highlights

• Pediatric respiratory expertise
• Caregiver education
• Respiratory assessments
• Clinical support
• Care coordination
• Partnership with Tennessee Medicaid initiatives