A Leading Care Transitions Model: Addressing Social Health Determinants Through Targeted Home Visits

A Leading Care Transitions Model: Addressing Social Health Determinants Through Targeted Home Visits

There's still time to register for tomorrow's webinar, A Leading Care Transitions Model: Addressing Social Health Determinants Through Targeted Home Visits.

Sun Health, an Arizona non-profit organization, launched its Sun Health Care Transitions program in November 2011. Modeled after the Coleman Care Transitions Intervention® and adapted to meet the needs of its community, the program has been credited with keeping readmission rates well below the national average.

Sun Health's program was part of the Center for Medicare and Medicaid Services' National Demonstration Program, Community-Based Care Transitions Program, which ended in January. Not only did Sun Health lead the CMS demonstration project with the lowest readmission rates, Sun Health also widened the gap between their expected 30-day readmission rate (56 percent lower than expected) and their expected 90-day readmission rate (60 percent less than expected).

A Leading Care Transitions Model: Addressing Social Health Determinants Through Targeted Home VisitsDuring the webinar, which starts at 1:30 p.m. Eastern, Jennifer Drago, FACHE, executive vice president, population health, Sun Health, will share the key features of the care transitions program, along with the critical, unique elements that lead to its success.

Register for the webinar today or order your training DVD or CD:
http://store.hin.com/product.asp?itemid=5213

You will learn:

  • How Sun Health adapted the Coleman Care Transitions Intervention® to meet the needs of its community;
  • The key roles of the care transition care team, which include a registered nurse, a licensed practical nurse and a social worker, and how and when they interact with the patient;
  • How addressing social health determinants and applying a chronic disease focus within the program improved results;
  • How Sun Health links to existing services in its community for aging in place to help address barriers to care plan adherence; and
  • Sun Health's approach to sustaining the program now that the CMS Community-Based Care Transitions Program demonstration project has ended.

You can "attend" this program right in your office. It's so convenient! Invite your staff members to participate in the conference. We will send you a login to access the webinar or a DVD or CD-ROM of the conference proceedings once it's available for shipping.

You'll also have the opportunity to have all of your questions answered by Ms. Drago during the interactive question and answer session. You'll get answers to your care transitions and home visits questions and challenges.

To register for the conference, the on-demand re-broadcast or MP3 download file or order the training DVD or CD-ROM of A Leading Care Transitions Model: Addressing Social Health Determinants Through Targeted Home Visits, please visit:
http://store.hin.com/product.asp?itemid=5213

I hope you find it useful.

Cordially,

Melanie Matthews
Executive Vice President
The Healthcare Intelligence Network

You may also be interested in these home visit resources from the Healthcare Intelligence Network: