Tag: Section 3026

Reaching Rural Residents: Improving Care Transitions in Western New York State

The P2 Collaborative of Western New York [name was changed to Population Health Collaborative in 2017] represents a different spin on the Community-based Care Transitions Program (CCTP) model. It is unique in its focus on a very rural area of Western New York, and is unusual in that it is one of a few  community-based

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SAGE: Bridging the Divide between Acute Medical Care and Social Services in Northeast Ohio

By Dr. Kyle Allen and Susan Hazelett The Summa Health System/Area Agency on Aging, 10B/Geriatric Evaluation Project(SAGE) is a collaboration between an integrated health system and the local Area Agency on Aging which was begun in 1995. SAGE  provided the organizational structure to develop the resources and processes needed to effectively integrate geriatric medical services

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Early Days: Chicago-Based CCTP Program Describes The Work To Date

CJE SeniorLife, a community-based organization that serves some 18,000 older adults annually, is among the first cohort of recipients for  Section 3026 or  Community-Based Care Transition Program (CCTP) funding from the Centers for Medicare and Medicaid. One of seven early awardees, CJE will anchor a project that includes three large hospitals in Northern Chicago, as

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Coalition Building for Care Transitions: Communities Work to Help Frail Elders

The following blog originally appeared on the Altarum Institute Health Policy Forum blog at http://www.healthpolicyforum.org on Tuesday, January 31, 2012. It is co-authored by Janice Lynch Schuster and Joanne Lynn. “Care transitions” is the new buzzword in efforts to improve health, improve care and reduce costs. It seems that everyone is jumping on the bandwagon,

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Southwest Ohio Care Transitions Collaborative Talks to Medicaring about CCTP Award

The Southwest Ohio Care Transitions Collaborative, one of 7 sites chosen by the Centers for Medicare and Medicaid for the first cohort of 3026 funding, had lots going for it as it pulled together a broad-based community health coalition and implemented strategies to reduce avoidable readmissions for older adults. The program brought to its application

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CMS Announced First Awards for CCTP Funding

CMS announced the first sites selected for the Community Based Care Transition Program. Please see the links below for the list of sites and an updated fact sheet. As noted above, we continue to accept applications and look forward to selecting additional sites in the near future. The following overview of the selected sites offers

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Dr. Joanne Lynn on the Community-Based Care Transitions Program

The Centers for Medicare and Medicaid launched Community-Based Care Transitions Program, or CCTP, to reimburse the costs of coordinating care across settings. Dr. Joanne Lynn gives an overview of the program, and how it will work to engage community-based organizations engaged in improving care transitions. Key words: Care transitions, Community-based care transitions, Section 3026, quality

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How to Build a Community Coalition to Address Care Transitions

Community-based coalitions are critical to improving care transitions. To this end, people working throughout the community, in a variety of settings, really need to work to get to know one another, understand each other’s systems, and develop solutions that will translate into effective services for the community. Dr. Joanne Lynn describes a few steps to

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AARP Factsheet Summarizes Health Care Reform Opportunities that Support Family Caregivers

In a factsheet from AARP’s Public Policy Institute, Lynn Feinberg and Allison M. Reamy  detail how provisions of the Affordable Care Act (ACA) will lead to better recognition of and support for family or informal caregivers. An estimated 40 million Americans are family caregivers, and provide everything from help with transportation to assistance with daily

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Better Care Transitions: Starting Points for Clinicians

As a frontline hospital or nursing home professional, you may be feeling increasingly frustrated with the lack of support, community follow-up and caregiver training for your vulnerable patients and residents. Despite your hard work these complicating factors are likely to send your patient or resident back to the hospital. Your administrators may have suggested to

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