Home Care

  • Berkshire Medical Center Reduces Readmissions

    Across the state hospitals are uniting with community-based organizations to form tight, integrated clusters of care with the goal of reducing hospital readmissions. Focusing on high-risk Medicare patients recently discharged from hospitals, and funded through Section 3026 of the Affordable Care Act, these Community-based Care Transition Programs (CCTPs) are successfully cutting avoidable readm...» Full Article
  • Norwell VNA Fights Readmissions

    A program at the Norwell VNA and Hospice that targets patients with Heart Failure (HF) has proven successful in reducing hospital admissions and readmission. The Norwell model relies on two foundational elements: (1) a strong clinical commitment to chronic care management using a wide-ranging team of providers and the patient, and (2) early intervention using telehealth technology. All of No...» Full Article
  • MetroWest’s Readmission Intervention Strategies

    In 2011, MetroWest HomeCare & Hospice, in partnership with MetroWest Medical Center, initiated a strategic and evidence based effort to reduce their emergent care visits and acute care hospitalization rates. The effort was initiated with the formation in November 2011 of MetroWest's Re-Admission Intervention Strategy Council (RISC).  The RISC includes representatives from management, nursi...» Full Article
  • Cambridge Health/Hallmark Health Reduce Readmissions

    Cambridge Health Alliance (CHA) and Hallmark Health, in collaboration with Somerville Cambridge Elder Services and Mystic Valley Elder Services, are among the top performers in an innovative national pilot program to reduce hospital readmission rates. The four organizations, known collectively as the Mystic Valley Community-Based Organization, joined 71 other community-based organizations (CBOs...» Full Article