At Advanced Care Management Solutions (ACMS) we deliver clinically
managed interventions to navigate the inequities of Social Determinants of
Health for the vulnerable patients we serve.
Scope of Need
All levels of healthcare seek care management solutions to inclusively engage patients and resources to achieve high-quality outcomes while curtailing inefficient spending. Our services enable patients to comply with medically sound care solutions. The individuals we seek to serve are predominantly elders and others living with physical and/or behavioral health challenges.
We understand the reality that patient compliance in regard to following healthcare guidance is based upon their ability to access community resources. Unfortunately, many patients may be adversely impacted by the inequities described as social determinants of health. We live in the communities we serve which affords us in-depth knowledge of navigating these barriers to more appropriately assist each patient and ensure their needs are met.
UDS focuses on improving patient outcomes by providing assistance for non-medical needs in conjunction with medical collaboration. When these items are unmet patients’ health may worsen and drive up costs. When assistance is provided for non-medical needs we see improved health and quality of life. That is what UDS is all about.
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Q & A
We provide oversight and management of patients for health care providers.
- Assess level of need
- Perform home visits as needed
- Develop a Person centered service plan
- Assist in paperwork completion for services and follow up
- Arrange services including application for waiver if appropriate
- Update person centered service plan
UDS focuses on improving patient outcomes by providing assistance for non-medical needs in conjunction with medical collaboration. We have over 55 years of experience with providing services in the community setting which leads to improved health and quality of life.
The individuals we seek to serve are predominantly elders and others living with physical and/or behavioral health challenges.
Renee Alston is our lead intake coordinator, she will complete the referral process with you and forward information to the appropriate team member.
Daria McBroom is our advanced care manager, she will reach out to you by the end of the next business day. Daria will arrange and ensure participant services in accordance with the assigned program requirements. In addition, she will mentor and oversee the daily activities of assigned transition service coordinators.
Jackie Weaver is our CRNP, she will conduct annual wellness visits (AWV) in the home and coordinate with the Care Managers under their supervision for Participant needs related to social determinants of health, to overcome healthcare inequities, behavioral health referrals and other needs identified in the AWV.
Dr. Susanne Scott is our Medical Director and collaborating physician for the ACMS program. She is an experienced board-certified family physician who aligns her talents with the UDS mission. She provides medical oversight of the clinical quality measures associated with social determinants of health and provides medical leadership for our team in caring for vulnerable individuals.
Complete the referral form on our web page or call us at 717 397-1841.
After completing the referral intake, our health care manager will contact you by the end of the next business day.
Our ACMS team includes a medical director, nurse practitioner, mental health professionals and social workers who can assist with drafting a plan of care and providing ongoing support for 6 months. This comes at no cost to your facility. On admission to your facility, our staff will contact you to set up a meeting to review our role in continuity of care.
Contact Us For More Information
Make A Referral
National Committee for Quality Assurance (NCQA) Accredited
UDS was one of the first service coordination agencies in Pennsylvania to receive NCQA accreditation. This addresses how case management services are delivered (not just the organization’s internal administrative process) to get to the heart of care coordination and quality of care. NCQA case management accreditation signals a commitment to the highest degree of quality improvement.
Meet Our Staff
Susanne Scott, MD, MPH
Jackie Weaver, RN, MSN, FNP-C
Advanced Health Care Manager
Advanced Care Manager
Wound Care Nurse
Lead Intake Coordinator