Inside Lonr’s 24/7 Care Navigation Model: Real People, Real Impact
When CMS’s mandatory Transforming Episode Accountability Model (TEAM) launches in January 2026, hospitals will be accountable for managing the entire 30-day surgical episode—from inpatient procedures to post-acute transitions, plus outcomes they’ve historically had limited oversight over.
This shift is not optional for many organizations. And financial penalties for readmissions, length of stay (LOS) variation, discharge disposition, and other quality metrics make it a high-stakes environment that many hospitals are unprepared for.
Yet, behind these regulatory demands is a simple truth: better patient care matters and, when done right, it can drive better hospital performance. That’s where Lonr Health comes in.
Why Concierge-Level Care Matters
Traditional case managers are often stretched thin, managing 30-40 or more patients each. The result? Patients get inconsistent support, transitions are fragmented, and readmission risk skyrockets.
Lonr’s concierge-level care model was built specifically to solve these challenges by delivering high-touch, personalized navigation that improves outcomes across the full episode of care.
Our approach isn’t outsourced or call center-based. Our 24/7 team is made up of our own experienced employees, including dedicated night-shift staff to maintain patient familiarity and continuity. This means patients always interact with someone who knows them, their case, and their needs.
For hospitals, this isn’t just about service, it’s about performance. When patients are supported consistently, they’re less likely to get readmitted, experience complications, or miss critical follow-ups.
How Lonr’s Care Navigation Improves Hospital Metrics
Lonr’s approach is designed to work seamlessly with your existing workflows. We extend your team and infrastructure to deliver better results for both the patients and the organization:
Reduce Readmissions
Our patient navigators and transition navigators provide comprehensive guidance to patients from pre-op to full recovery. By following patients for 30-90 days post-discharge, answering questions 24/7, and managing transitions, we address complications early, reducing unnecessary readmits.
Result: 4% 30-day readmission rate (vs. 10–15% national average)
Optimize LOS and PAC Utilization
We guide discharge planning to avoid unnecessary skilled nursing facility (SNF) stays, reduce LOS variation, and ensure patients return home safely when appropriate.
Result: Controlled post-acute costs and better alignment with CMS episode targets
Improve Discharge Efficiency
Transition navigators ensure patients leave the hospital with clear, achievable plans, including medication adherence, transportation, and follow-up scheduling. We connect patients with the right in-network specialists should they need additional care and ensure smooth transition between facilities.
Result: 85% of post-surgical patients regain full mobility within 6 months
Drive Patient Adherence and Satisfaction
Lonr’s dedicated navigators help patients understand and follow their care plans, reduce anxiety, eliminate confusion around fragmented care, and address social barriers like transportation or resources.
Result: 95% follow-up visit compliance and 91% patient satisfaction
Provide Real-Time, Actionable Data
Through regular touchpoints, we deliver daily insights into patient status, risk flags, and progress for better care coordination. Lonr uses this data to provide personalized care strategies, while physicians can see who’s "on track" vs. "off track" and proactively intervene if needed.
Result: Predictive, data-driven care strategies that improve outcomes and provide an average MLR reduction of 13.5%
Aligning Care to Meet TEAM Requirements
Hospitals are facing one of the most significant care management shifts in recent memory, but Lonr’s concierge-level care model is a strategic tool for hospitals to succeed under TEAM.
With Lonr, hospitals can build sustainable, high-performing care management strategies that reduce penalties, control spend, and deliver better patient outcomes.
Learn more about how Lonr’s concierge-level patient care can help your team thrive under TEAM.