Healthcare Partnership Services
Your Health, Our Priority
Bridging the gap between hospital and home — connecting patients with nurse practitioners, caregivers, and therapists for seamless, compassionate care.
A smarter approach to transitional care
Executive Overview
Optimum Healthcare Partners (OHP) delivers a next-generation Transitional Care Medicine (TCM) telehealth model designed to improve post-discharge outcomes, strengthen care coordination, and reduce costly readmissions. OHP serves as an extension of your hospital's care team, ensuring that every discharged patient receives proactive, structured follow-up within the first 30 days — a critical window for preventing complications and promoting recovery.
Clinically Led
Data Driven
Outcome Focused
Patient Centered
Outcomes that speak for themselves
Measured Impact
A clinician-led virtual support system
Our Transitional Care Model
OHP's Transitional Care Medicine (TCM) program provides a seamless, clinician-led virtual support system that begins immediately after hospital discharge. Each patient receives individualized attention through telemedicine or phone visits, ensuring that follow-up care is delivered promptly, efficiently, and compassionately.
Key program elements include:
- Review and clarify discharge summaries and care plans
- Coordinate follow-up appointments, diagnostics, and referrals
- Educate patients and caregivers on condition management
- Screen for early complications and social determinants of health
- Reconcile medications to ensure adherence and safety
- Engage multidisciplinary care teams for complex cases
HIPAA-compliant telehealth built for hospitals
Technology-Driven Care Coordination
OHP's HIPAA-compliant telehealth platform integrates directly with hospital EHRs, enabling real-time data exchange, automated alerts, and analytics-driven oversight. Our technology empowers clinicians to identify high-risk patients early, track recovery progress, and escalate interventions before readmission risk escalates.
EHR Integration
Direct integration with hospital EHR systems for real-time data exchange.
Automated Alerts
Proactive notifications flag high-risk patients before complications arise.
Analytics-Driven Oversight
Track recovery progress and outcomes with live dashboards and reporting.
HIPAA-Compliant Platform
Secure, compliant communication across the entire care team.
Aligned incentives. Proven results.
Value for Hospital Partners
We work as a true extension of your clinical team — not a vendor, but a partner. Our model is designed to align with value-based care contracts, CMS quality metrics, and hospital readmission reduction programs, delivering financial and clinical returns from day one.
Partnering Across the Care Continuum
Patients & Families
We help coordinate your transition from hospital to home, ensuring you have the right support every step of the way.
Nurse Practitioners & Clinicians
Partner with us to extend your reach into home care settings and deliver continuity of care.
Caregivers & Therapists
Join our network of dedicated professionals supporting patients in acute and home care environments.
Care That Follows You Home
Optimum Healthcare Partners specializes in connecting patients with the skilled professionals they need — from acute care transitions to ongoing home support. Our network of nurse practitioners, caregivers, and therapists is here to ensure no patient falls through the cracks.
Contact Us
Your next great partnership starts here!