This week's insight...
Senior Director of Program Development at UPMC Health Plan
August 29, 2012
Vol. I, No. 15
Debra Smyers, Senior Director of Program Development at UPMC
For Further Reading:
Which Community Care Team Members "Most of our members have social needs, in which case we start with a social worker going into the visit first. We’ve just added our Medicare members, who have more medically complex issues. In those cases, it’s the nurse who will start the visit. We make that determination based on their services and the types of conditions that they have.
Conduct Home Visits and How Often?
As far as frequency, when the team goes in the first month, we’re usually there once a week in the home, with some telephonic follow-up with the patient and connections with community agencies, primary care physicians, etc. We then taper it off to every two weeks and then down to once a month. On average, we see our patients in their homes for about three months there are some that go longer but it seems that three months is a good time for us to stabilize the patient and hand them over to somebody else to continue assisting them."
Debra Smyers presented during Identifying, Engaging and Breaking Down Patient Barriers To Reduce Avoidable ED Use, a 45-minute webinar replay, during which she shared the inside details on UPMC's five-pronged approach to target avoidable ED visits.
Read related blog post: 3 Key Questions to Ask ED Patients to Reduce Utilization
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