Chronic Conditions Most Seen in the ED
59.5% of adult ED visits are for patients with chronic conditions according to a study published in the National Health Statistics Reports.
Dementia Patients Experiencing Higher Readmissions
Dementia patients face significant challenges when it comes to hospital readmissions due to their complex care needs, cognitive impairments, and the frequent presence of multiple chronic conditions.
What are the Average 30-Day Readmission Rates Across U.S. Hospitals?
September/October 2024 Issue
SUBSCRIBER CONTENT Readmission rates are critical for hospitals and ACOs as they work to improve patient outcomes and reduce unnecessary healthcare costs through better care coordination and patient education. This article provides critical readmission data related to average readmission rates, condition-specific readmission rates, and hospitals with high and low readmission rates.
ACOs: The Critical Role of Care Coordinators in Discharge Planning and Care Transitions
Lessons from 20 Medicare Shared Savings Programs provide insight into how ACOs manage complex care patients.
ACOs: Care Transitions for Complex Patients
ACOs often employ care management programs that follow evidence-based strategies for increasing the value of care delivered to people with complex needs.
ACOs: 6 Home Care, Hospice, and Telehealth Benefit Waivers
The Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, a program from CMS, is testing home care benefits, hospice benefits, and telehealth, as well as who can perform home care visits.
This ACO Model is Testing the Future of Home Care and Waivers
Care Continuum: Reports just published prove ACOs are saving Medicare money! The next generation ACO is expanding and testing home care through six new benefits including waivers, expanding the role of the nurse practitioner and piloting a value-based payment. This went into motion July 1. We explain in detail how this impacts home care.
ED Patients: Partnering with Home-Based Care to Fill Gaps in Care
The emergency department (ED) is the hospital's front door, providing over 70% of all hospital admissions. How can home-based care providers partner with EDs?
ACO MarketScan: Payments Shifting Care at Home Volume
March/April 2024 Issue
SUBSCRIBER CONTENT ACO MarketScan: What makes it crucial for home care providers to establish connections with ACOs? With more than half of Medicare beneficiaries enrolled in accountable care organizations, aiming for 100%, home care providers must craft compelling value propositions and engagement strategies to foster partnerships.
Hospital MarketScan: Hospital Outcome and Quality Measures
March/April 2024 Issue
SUBSCRIBER CONTENT Hospital MarketScan: A thorough grasp of hospital quality and outcomes proves highly advantageous for home care providers. Establishing and fortifying referral partnerships with hospitals and health systems necessitates a more comprehensive understanding of hospital outcomes and quality measures to enhance relationship building efforts.
In Case you Missed This
March/April 2024 Issue
SUBSCRIBER CONTENT Hospital at home updates you may have missed.
Team-Based Care – A 2024 Strategy
January/February 2024 Issue
SUBSCRIBER CONTENT ENVIRONMENTAL SCAN: Team-based and multidisciplinary teams underpin the success of value-based care models and hospitals-at-home. Cross-collaborative teams in specialty clinical programs are making their way between hospitals and home care organizations. This is the next level of clinical integration and for stakeholders to better understand home care’s value.
Synergistic Referral Partnerships Gain Traction
January/February 2024 Issue
SUBSCRIBER CONTENT ENVIRONMENTAL SCAN: Referrals are more dependent on home care as partners for financial, quality, and patient experience measures. Shifting payments are changing traditional views of managing a patient’s care journey. Each segment of healthcare will contribute to a synergistic success level. No organization can do it alone.
Social Determinants: Changes Ahead in 2024
January/February 2024 Issue
SUBSCRIBER CONTENT ENVIRONMENTAL SCAN: Screening requirements for social determinants in 2024 are front and center for hospitals, dialysis centers, physicians, and post-acute providers. Coordination across various healthcare settings, including ambulatory, emergency department, inpatient, and home health will create a unified approach.
More Hospitals Facing Readmission Penalties in 2024
November/December 2023 Issue
SUBSCRIBER CONTENT More hospitals will face readmissions penalties in 2024, per preliminary CMS data. The Centers for Medicare and Medicaid Services will restart its pneumonia readmissions measure.
2023 Providers are Responsible for Social Determinants of Health Quality Measures
Research shows that social determinants can be more important than health care or lifestyle choices in influencing health. Numerous studies suggest that SDOH account for between 30-55% of health outcomes.
Lack of Patient Discharge Instructions Disrupt Care Transitions
May/June 2023 Issue
FREE CONTENT Learn the five key areas that home-based care organizations could assist in discharge planning.
What Motivates ACOs to Make Home Visits?
March/April 2023 Issue
SUBSCRIBER CONTENT Learn the seven reasons why ACOs use home care and what’s behind the motivation.
Senior Care Profiles
March/April 2023 Issue
SUBSCRIBER CONTENT The profile of seniors is changing according to the Administration on Aging. Get the latest information.
Why Collaboration Across the Care Continuum Improves ACO Patient Experience
March/April 2023 Issue
SUBSCRIBER CONTENT A study out of the Ohio State University Fisher College of Business explores factors that can help ACOs deliver more efficient and effective health care, by how much and the costs associated with these improvements.
5 Changes to Social Determinants of Health Quality Measures Across the Continuum 2023
January/February 2023 Issue
SUBSCRIBER CONTENT New social determinants of health (SDOH) quality measures will be required by hospitals, health plans, and multi-payer federal and state programs. We provide details on how each healthcare sector will be incorporating SDOH quality measures.
5 Ways Health Equity is Advancing in Medicare Models
January/February 2023 Issue
SUBSCRIBER CONTENT In this article, we explore the models of care advancing health equity and the closer connection to value-based care.
Which Types of ACOs Use Home Visits the Most and Why?
November-December 2022 Issue
SUBSCRIBER CONTENT Home-based organizations eager to have partnerships with ACOs will learn in our discussion why certain ACOs engage in greater home visits and care transitions to manage complex patients. No two ACOs are alike. Get insights into the characteristics of ACOs and their decision points. We follow up with three key leadership discussion questions.
ACOs Perspective About Home-Based Care
A recent study in the Journal of Managed Care was an eye-opener when it comes to better understanding home-based care from an ACO perspective.
Discharge Planning Patterns: Care Transitions and Readmissions
March/April 2022 Issue
FREE CONTENT A recent study examined the patterns of Medicare beneficiaries post-acute care transitions among assisted living residents and their outcomes in the first 30 and 60 days after hospital discharge.
ACOs: Five Important Facts Changing Up Participation
November-December 2021 Issue
SUBSCRIBER CONTENT Get insight into how ACOs are performing and related changes to their future.
The Ten Most Frequent Diagnoses for Inpatient Stays
September/October 2021 Issue
FREE CONTENT In this article, we discuss the 10 most frequent principal diagnoses and their costs impacting hospital inpatient stays.
Six Smart Ways to Stay in Communication with Your Referral Sources
September/October 2021 Issue
SUBSCRIBER CONTENT Your referral partners increasingly expect robust communications to make patient transfers as seamless as possible, for both the patient and providers. They will have to make a choice. Ultimately, they will look for relationships with organizations that are easy to work with and that can deliver proven quality care. We provide insights and strategies from high-performing organizations.
What Program is the Biggest Winner for Home-Based Care?
September/October 2021 Issue
SUBSCRIBER CONTENT Read the insights about home-based primary care and how they have reduced hospitalizations, readmissions, and emergency room visits.
Five COVID Waivers the American Hospital Association is Urging CMS to Keep That Impact Your Organization
September/October 2021 Issue
SUBSCRIBER CONTENT The American Hospital Association is urging CMS to keep five COVID waivers and to not return to the old ways of doing things.
Legal Perspective on Patient Choice
What are the fraud implications when patients' rights are violated? What is the role of physicians in patients' freedom of choice? The Remington Report gets answers from Attorney Elizabeth Hogue.
2021 Healthcare Outcomes Go Statewide and Regional
January/February 2021 Issue
A growing number of initiatives are expanding to address social determinants of health. Payers, health systems, community-based organizations, and government entities are partnering together to create statewide efforts to improve community health and social care.
COVID-19 Discharge Planning Waivers Link to Patients’ Freedom of Choice
The Centers for Medicare and Medicaid Services (CMS) has issued a number of waivers of various requirements for healthcare providers related to discharge planning for hospitals and critical access hospitals (CAHs).
COVID-19: Protecting Healthcare Workers
Concern for healthcare workers in every setting knows no bounds! Providers' imperative is clear: everything possible must be done to keep them safe.
Case Study: Payer and Provider Model: Managing Higher Acuity in the Home
Landmark estimates about 20 percent of chronically ill patients currently experience a gap in the care they are receiving, which can be addressed through medical care, support and education provided in the home.
2020 ACOs Taking on More Risk
The number of ACOs taking on risk for cost increases grew from 93 ACOs at the start of 2019 to 192 at the start of 2020.
Discharge Planning: Adding Caregivers Reduces Readmissions
Including unpaid caregivers into discharge planning for the elderly patient population reduces readmissions.
Discharge Planning Process Requires Post-Acute Quality Measures And More
New Discharge Planning Conditions of Participation require hospitals to assist patients, their families/caregivers in selecting a post-acute care provider.
Emergency Dept. Study: Top 10 Reason Heart Failure Patients Go To The ED
A study in the Annals of Emergency Medicine, looked at why heart failure patients go to the Emergency Room.
Discharge Planning: Adding Caregivers Reduces Readmissions
Including unpaid caregivers into discharge planning for the elderly patient population reduces readmissions.
Montefiore Health System’s Care Management Program
SUBSCRIBER CONTENT Located in the Bronx and Hudson Valley, New York, Montefiore Health System (MHS) serves one of the poorest and most disproportionately disease-burdened counties in the nation with nearly 80% of the payer mix from Medicare and Medicaid.
Reducing Falls and Falls with Injury in HealthEast Hospice Patient Population
SUBSCRIBER CONTENT Multidisciplinary teams across the care continuum work each day to determine the best ways to identify the highest risk patients.
Pharmacist Post-Discharge Model Reduces Medication Errors
SUBSCRIBER CONTENT Novant participated in a VHA research project that significantly reduced overall readmissions and those related to adverse drug events.
From Hospital to Home: Knee & Hip Replacement Model
SUBSCRIBER CONTENT From July to December 2014, VNA Healthtrends, a leading home health provider, enrolled 51 patients in their Hospital to Home Program.
ACO Investment Model
The ACO Investment Model encourages new ACOs to form in rural areas and Medicare Shared Savings Program ACOs to take greater financial risk.
Medicaid ACO Market Scan
17 states are implementing accountable care strategies in Medicaid or state employee health programs and patterns have begun to emerge.
ACOs: Three Approaches to Improve End-of-Life Care
The ACO model has the right incentives to reduce variation, spur innovation, and improve quality in end-of-life (EOL) care
ACO and Home-Based Palliative Care Model Reduce Costs
SUBSCRIBER CONTENT A home-based palliative care program tested within an ACO showed cost savings and reduced hospital admissions for patients near the end of life.
The ACO Medicare-Medicaid Model for Managing High-Risk Patients
The ACO Medicare-Medicaid Model is focused on improving quality of care, improved care coordination, and reducing costs for Medicare-Medicaid enrollees.
ACOs: Lowering Medicare Spending Per Beneficiary for High-Need Patients
A study by Dartmouth Institute For Policy and Clinical Practice finds coordinated care for patients with complex needs a big winner for ACOs.
How ACOs Manage High-Risk, High-Need Patients
A study in The American Journal of Accountable Care provides a window into how ACOs manage high-risk, moderate-risk and low-risk patients.
Discharge Planning: The New Focus on Patient Choice and Choosing Post-Acute Providers
SUBSCRIBER CONTENT MedPAC has had recent discussions on current discharge planning procedures, resulting in possible changes in the ways patients are discharged.
Hospitals Can Provide Free In-Home Services to Discharged Patients: OIG Advisory
The OIG posted Advisory Opinion No. 10-03 on March 6, 2019, which permits hospitals to provide free, in-home follow up care to discharged patients.
