Preventing avoidable hospital admissions and readmissions is a mounting priority for policymakers and health systems across the U.S. A new case study series examines the potential of three promising care management programs designed to reduce hospitalizations or rehospitalizations for high-risk patients: Cincinnati Children's Hospital Medical Center’s Asthma Improvement Collaborative, UCSF Medical Center's Heart Failure Care Management Program, and the Visiting Nurse Service of New York's Choice Health Plans, which serve special-needs patients dually enrolled in Medicare and Medicaid.
Collaboration among hospitals, home health agencies, and social service providers—as well as patients and their caregivers—is key to improving care transitions and stemming the tide of unnecessary readmissions, say experts from the Institute for Healthcare Improvement and The Commonwealth Fund in a Journal of the American Medical Association "Viewpoint." To promote collaborative efforts, reimbursement systems should spread costs and savings alike across all providers.