Empowering Wellness in Tampa
Care coordination is more than medical management; it's about empowering individuals to achieve and maintain their highest level of physical and mental well-being. At Ibis Healthcare, our certified care coordinators in Tampa work with high-utilizer patients and individuals with complex medical conditions to navigate healthcare systems, reduce hospital re-admissions, and improve overall health outcomes.
Licensed Clinician, Karl Knox, LMHC, with 14 years of experience in hospital case management and care transitions, leads our multidisciplinary team of nurses, social workers, and community care managers who are dedicated to helping Tampa Bay residents achieve sustainable wellness and independence.
Our evidence-based care coordination programs have achieved an 85% reduction in crisis hospitalizations and emergency room visits, demonstrating the power of comprehensive, person-centered care management in transforming lives and reducing healthcare costs.
Two Comprehensive Care Coordination Programs
High Utilizers Program
Targeting Complex, High-Need Individuals
Our high utilizers care coordination program specifically targets adults who frequently access crisis services, emergency departments, and acute care facilities, creating intensive support systems to break the costly cycle of repeated hospitalizations and emergency interventions.
Target Population Characteristics:
- Adults 18 years and older with complex medical and behavioral health needs
- High utilizers of behavioral health services (typically 3+ crisis/detox admissions within 180 days)
- Individuals with frequent emergency department visits for non-emergency concerns
- People with repeated jail utilization often related to untreated mental illness or substance abuse
- Those experiencing chronic homelessness or housing instability
- Individuals with co-occurring medical, behavioral health, and substance use conditions
Comprehensive Assessment and Intervention
Initial Assessment Process: Our certified care coordinators conduct thorough biopsychosocial assessments to identify:
- Medical conditions and healthcare needs
- Behavioral health and substance abuse treatment requirements
- Social determinants of health including housing, transportation, and financial stability
- Existing support systems and community connections
- Barriers to healthcare access and treatment engagement
- Individual strengths, preferences, and goals
Intensive Intervention Strategies: Whatever it takes
- High-Frequency Contact: Multiple touchpoints per week during initial stabilization phase
- Crisis Prevention Planning: Comprehensive safety planning and emergency response protocols
- Housing Stabilization: Emergency housing assistance, permanent supportive housing applications, and tenancy support
- Healthcare Navigation: Assistance with provider appointments, insurance issues, and care coordination
- Benefits Advocacy: Support with disability applications, insurance enrollment, and financial assistance programs
Private Care Coordination Program
Hospital-Based and Community Integration
Our private care coordination services are strategically co-located within emergency departments and hospital systems throughout Tampa, providing immediate support for patients with complex medical conditions during critical transition periods.
Strategic Service Locations:
- Hospital emergency department and other major hospital systems
- Outpatient specialty clinics and medical practices
- Rehabilitation facilities and skilled nursing facilities
- Community health centers and federally qualified health centers
Target Patient Population:
- Individuals with complex, chronic medical conditions requiring intensive care management
- Patients at high risk for hospital readmission within 30 days of discharge
- Those requiring complex care transitions between levels of care
- High-risk individuals identified through predictive analytics and claims data
- Patients with frequent emergency department utilization for ambulatory care-sensitive conditions
What Services Do We Provide?
Transportation and Access Services
Overcoming Barriers to Healthcare Access
Transportation barriers significantly impact health outcomes, particularly for individuals with disabilities, older adults, and those without reliable transportation. Our care coordination team provides comprehensive transportation solutions.
Medical Transportation Coordination
Scheduled Medical Appointments:
- Coordinating Medicaid transportation services and non-emergency medical transportation
- Arranging driver programs and community transportation services
- Providing public transportation training and bus pass assistance
- Coordinating family and caregiver transportation support when appropriate
Emergency Transportation:
- Coordinating emergency transportation for urgent medical needs
- Facilitating ambulance services when medically necessary
- Arranging emergency transportation for psychiatric crises and behavioral health emergencies
- Supporting transportation to emergency departments and urgent care facilities
Specialty Care and Diagnostic Services:
- Transportation to specialist appointments and consultation visits
- Coordination of transportation for diagnostic testing and imaging services
- Support for transportation to surgical procedures and outpatient treatments
- Facilitating transportation to dialysis, chemotherapy, and other ongoing treatments
Evidence-Based Outcomes and Quality Metrics
Proven Results in Tampa Bay
Ibis Healthcare's Care Coordination Team reduces recidivism to a CSU or high Emergency Room usage by 85%, demonstrating the effectiveness of comprehensive care management in improving health outcomes while significantly reducing healthcare costs and system burden.
Additional Outcome Measures and Success Metrics
Healthcare Utilization Improvements
- Reduced Hospital Readmissions: 30-day readmission rates decreased by 60% among program participants
- Emergency Department Utilization: Non-emergency ED visits reduced by 75% through improved primary care access
- Crisis Intervention Reduction: Psychiatric emergency services utilization decreased by 80% through crisis prevention planning
- Preventive Care Engagement: Annual wellness visits and preventive screenings increased by 90% among participants
Quality of Life and Functional Improvements
Health Status Improvements:
- Improved medication adherence rates exceeding 85% among participants
- Better management of chronic conditions with reduced complications
- Enhanced self-care abilities and health literacy
- Increased confidence in navigating healthcare systems
Social and Economic Outcomes:
- Housing stability maintained or improved for 95% of participants
- Increased access to benefits and financial support services
- Enhanced family relationships and social support networks
- Improved quality of life scores and overall well-being measures
Referral Sources and Partnership Network
Primary Referral Partners
- Ibis Healthcare EMR System: Internal referrals from integrated behavioral health services
- Central Florida Behavioral Health Network: Regional network partner referrals and coordination
- Hospital Case Management Teams: Direct referrals from emergency departments and inpatient units
- Primary Care Practices: Referrals from family medicine, internal medicine, and community health centers
- Specialty Medical Clinics: Referrals from cardiology, endocrinology, nephrology, and other specialist practices
Flexible Service Duration
Our care coordination adapts to each patient’s needs, ensuring the right level of support—freeing hospital beds sooner while still maintaining quality outcomes.
Typical Service Duration
Within 60 Days
Standard care coordination and stabilization within 60 days helps patients transition safely out of the hospital, reducing the need for extended inpatient stays.
Short-Term Interventions
Within 30 Days
Targeted, focused interventions within 30 days address immediate needs quickly—minimizing readmissions and keeping beds available for new patients.
Extended Support
Up to 4–5 Months
For patients with complex, multiple conditions, extended support prevents repeated hospitalizations and ensures long-term stability—optimizing bed availability for higher-acuity cases.
Maintenance Services
Periodic check-ins for chronic conditions prevent unnecessary hospital returns, ensuring long-term bed capacity is preserved.
Connect with Our Care Coordination Team
Ready to experience the difference that professional care coordination can make in your health journey? Our Tampa team is committed to supporting you in achieving your wellness goals and maintaining your independence in the community.
Contact Information:
- Phone: 813-272-2244
- Email: carecoordination@ibishc.org
Professional Referrals: Healthcare providers, social workers, and discharge planners can contact us directly for consultation and referral coordination.
Service Areas: We provide care coordination services throughout Hillsborough County
"whatever it takes to achieve wellness"