The following analyses contain community-specific data:
Stand-Alone Charts of 30-Day Rehospitalization Data
The mix of patients, healthcare providers, and community resources is different for each local effort. Read how it all comes together for a sampling of the communities we are assisting:
- Kitsap County, WA providers find the timing is right to collaborate on care transitions
“Looking back over her years in healthcare, Annette Crawford, LNHA, the Administrator at Stafford Healthcare at Ridgemont (a skilled nursing facility located in Port Orchard, WA) recalls “I was definitely part of the problem. I’m very competitive and didn’t want to talk about internal processes.” Read the story, published December 2012.
In addition, check out the video that Medicare's National Coordinating Center (NCC) for the Integrating Care for Populations and Communities Aim created recognizing the outstanding work of the Kitsap County Cross Continuum Care Transitions Project (KC4TP).
- A widespread community in Eastern Washington/North Idaho applies for CCTP funding and forges new connections along the way
“We’ve been around 34 years, but we’ve never worked with hospitals like we are now, and we hadn’t collaborated as closely with the Visiting Nurse Association before,” said Anne Whigham, the Case Management Operations Manager for Aging & Long Term Care of Eastern Washington (ALTCEW). But then Section 3026 of the Affordable Care Act created the Community-based Care Transitions Program (CCTP), spurring organizations across the Inland Northwest to join forces. Read the story, published May 2012.
- In 2008-2011, Qualis Health led one of Medicare's pilot projects focused on care transitions. Read more about the innovative Stepping Stones project in Whatcom County, WA.