Hospital readmissions within 30 days are a leading quality metric for discharge planners at Valley Baptist Medical Center, Valley Regional Medical Center, and South Texas Health System. Our transition care service bridges the gap between discharge and full recovery, reducing readmission risk through consistent, supervised in-home support and real-time care coordination.
Patients being discharged from any RGV-area hospital enrolled in STAR+PLUS, PHC, Driscoll Health Plan, or private pay. Discharge planners and MCO coordinators can call (956) 594-8188 to initiate a referral with a 24–48 hour care start commitment.