Improve Outcomes

We have created a robust Chronic Disease Management program with our experienced and proven team that helps:

  • reduce overall cost of healthcare by achieving better treatment outcomes and proactive health management.
  • ensure increased and timely collaboration between Physician and Patient through our robust model.
  • grab post discharge healthcare maintenance and intelligence around Patient behavior.

OUR Departments

  • Prevention and Wellness

    Maxlink Health offers preventive services thru meaningful and engaged communication methods with targeted population to promote preventive screenings, vaccinations, diagnostic tests and participation in wellness programs. Our team of dedicated RNs and Certified team of Wellness experts are available to guide.

  • Transitional Care

    Our Team of Transition of care program Nurse Care Coordinators offer regular phone conversations to track patient Progress – Pre-appointment planning and facilitating Medical appointments. The Nurse case managers — or transition navigators connects with patients striving to understand and resolve each individual's unique barriers to care.

  • Readmission Prevention

    Specific emphasis given by this department in following patients discharged with certain diagnosis such as Congestive Heart Failure, COPD, Pneumonia affect 30-day unplanned hospital readmissions.

  • TeleHealth

    Telehealth department handles all calls for preventive, transitional and chronic care management. The 24X7 Nurse Hotline is also maintained 365 days effectively.


    Survey is administered between 48 Hrs to 6 weeks post discharge by the Hospital Surveyors, however the Maxlink Health HCAHPS Team maintains patient engagement via timely communication with each patient from the day patient is admitted till 90 days of discharge.

  • Health Education and Training

    Maxlink Health RN coordinators involved in Education specialize in certain aspects of care coordination. We have one nurse, for example, who is certified as an asthma educator. All RN Coordinators are very skilled in the art of care coordination. Motivational interviewing. We use evidence-based chronic and preventive care protocols to identify and educate patients.

Organizing Follow Up appointments:

Patients who lack an outpatient appointment at the time of discharge represent 50% of readmitted cases nationwide. Relying on patients to make this initial appointment when they return home increases the risk that appointment setting will not happen.

A simple way to help them take this step that does not require a complicated process is to give them the date and time of the appointment after coordinating with Physicians office and the patient. This can be achieved easily by the RN Coordinator during the initial phone conversation with the patient as per the discharge instructions from the hospital. Assigned RN Coordinator also ensures that the patient has all the reminders and arrangements to reach the Physician office for the scheduled appointment. This completely takes away the guess work and once the Patient completes the visit, RN coordinator coordinates with Physicians office to schedule any further follow up, any new medications, diagnostics performed or to be performed. The information helps the RN Coordinator to keep the patient aligned with the providers care plan and adherence.