Tag Archives: care transitions

Kaiser Permanente’s Total Panel Ownership Avoids ‘Cookie Cutter Medicine’

Population care in the form of cookie cutter medicine will not work, says Jim Bellows, Ph.D., senior director of evaluation and analytics for Kaiser Permanente. Instead, care has to be dispensed “one member at a time,” the philosophy behind total … finish reading Kaiser Permanente’s Total Panel Ownership Avoids ‘Cookie Cutter Medicine’

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Data Dive Uncovers Socioeconomics Driving ER Visits, Readmissions

By diving deep into existing data, officials at John C. Lincoln Network accountable care organization (ACO) realized the primary cause of readmissions for a subset of patients wasn’t inaccessible primary care, but lack of food. Patients were going to the … finish reading Data Dive Uncovers Socioeconomics Driving ER Visits, Readmissions

Posted in Avoidable Hospitalization, Cardiac Care, Care Coordination, dual eligibles, Elderly Care, Hospital Readmissions | Tagged , , | Leave a comment

4 Reasons to Develop a Post-Acute Care Coordination Network

Capacity issues and resulting loss of revenue, and concerns about adequate discharge plans prompted Summa Health System to develop an SNF care coordination network, explains Carolyn Holder, MSN, RN, GCNS-BC, manager of transitional care, resulting in improved patient care and … finish reading 4 Reasons to Develop a Post-Acute Care Coordination Network

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4 Strategies to Reduce Readmissions, Cost of Medically Complex

Targeting frail elderly patients at high risk of preventable healthcare utilization, and providing them with telephonic case management support at two critical transitions — after they’ve been admitted to the hospital, and after they’ve been discharged from home visits — … finish reading 4 Strategies to Reduce Readmissions, Cost of Medically Complex

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Home Visits One of Four Key Trends in Medication Adherence Initiatives

Home visits are becoming the rule rather than the exception for organizations seeking to improve medication adherence rates. Nearly half (47 percent) of the respondents to HIN’s Medication Adherence in 2013 survey in January 2013 said they checked in with … finish reading Home Visits One of Four Key Trends in Medication Adherence Initiatives

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Care Transitions Prime Opportunity for Patient-Centric Case Management

Hospital-to-home or hospital-to-nursing home transitions offer a wealth of opportunity for intervention, the first being medication management and medication reconciliation, say Doreen Salek, director of business operations of health services, and Janet Tomcavage, RN, MSN, vice president of health services … finish reading Care Transitions Prime Opportunity for Patient-Centric Case Management

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1 in 4 Medicare Beneficiaries Returns to ER after Nursing Home Discharge

A high percentage of Medicare patients who are discharged from nursing homes are returning to the hospital or emergency rooms (ER) within 30 days, according to a study from the University of North Carolina at Chapel Hill School of Nursing. … finish reading 1 in 4 Medicare Beneficiaries Returns to ER after Nursing Home Discharge

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New Hospital to Home Initiative Improves Strategies to Prevent Readmissions

Participation in a new hospital to home quality improvement initiative has helped to improve hospital readmission strategies, including tracking discharged patients and partnering with local hospitals, according to a study published in JAMA Internal Medicine. Researchers from the American College … finish reading New Hospital to Home Initiative Improves Strategies to Prevent Readmissions

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NaviHealth/Cigna-HealthSpring Partner to Improve Post-Acute Care, Costs

Hoping to improve care quality and outcomes for an estimated 100,000 post-acute patients in the heavily populated Mid-Atlantic and Pennsylvania markets, Cigna-HealthSpring and naviHealth are joining forces, according to releases from both organizations. The collaboration will utilize naviHealth’s technology (which … finish reading NaviHealth/Cigna-HealthSpring Partner to Improve Post-Acute Care, Costs

Posted in Accountable Care Organizations, Care Coordination, Case Managers, Case Managers and the Patient Experience, Skilled Nursing Facilities | Tagged , , , , | Leave a comment

7 Barriers to Effective SNF-Hospital Care Transitions

A lack of quality information from nursing facilities when a patient was transferred to an ED was one barrier task force members tackled when developing their skilled nursing facility (SNF) care coordination network, explains Mike Demagall, LNHA, LPN, administrator with … finish reading 7 Barriers to Effective SNF-Hospital Care Transitions

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