All Innovations

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Monitoring Medical Home Implementation

July 10, 2013 - The Patient-Centered Medical Home Assessment is a self-assessment tool that was developed by the MacColl Center for Health Care Innovation and Qualis Health for the Safety Net Medical Home Initiative to help practices understand to what degree they function as a medical home and to identify opportunities for improvement.

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Becoming a Medical Home: Implementation Guides

July 10, 2013 - The patient-centered medical home is a model of primary care that can improve health care quality as well as clinicians', staff members', and patients' experiences. The model can also increase efficiency. As part of the Commonwealth Fund-supported Safety Net Medical Home Initiative, Qualis Health and the MacColl Center for Health Care Innovation have identified eight key strategies that primary care sites can implement to become patient-centered medical homes.

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The Colorado Beacon Consortium: Strengthening the Capacity for Health Care Delivery Transformation in Rural Communities

April 18, 2013 - This case study describes how one of the 17 Beacon sites, the Colorado Beacon Consortium, has strengthened the capacity of local health care providers to exchange health data and transform clinical care.

Case Study

The Veterans Health Administration: Taking Home Telehealth Services to Scale Nationally

January 30, 2013 - This case study highlights factors critical to the VHA's success—like the organization's leadership, culture, and existing information technology infrastructure—as well as opportunities and challenges.

Case Study

Partners HealthCare: Connecting Heart Failure Patients to Providers Through Remote Monitoring

January 30, 2013 - Partners HealthCare's programs in home telehealth have been driven by its Center for Connected Health, which has pilot-tested and implemented telemedicine and remote monitoring solutions.

Case Study

Scaling Telehealth Programs: Lessons from Early Adopters

January 30, 2013 - This synthesis brief offers findings from case studies of three early remote patient monitoring adopters: the Veterans Health Administration, Partners HealthCare, and Centura Health at Home.

Case Study

Centura Health at Home: Home Telehealth as the Standard of Care

January 30, 2013 - This case study looks at the results from the year-long program that demonstrated successful outcomes in terms of reducing 30-day rehospitalizations, increasing patients' quality of life, improving patients' self-management skills and education, and reducing the frequency of home visits from registered nurses.

Case Study

Gaining Ground: Care Management Programs to Reduce Hospital Admissions and Readmissions Among Chronically Ill and Vulnerable Patients

January 23, 2013 - Preventable hospital admissions and readmissions are indicators of health system fragmentation associated with suboptimal patient outcomes and avoidable costs of care. This synthesis report looks at three case studies that illustrate the potential of care management programs to address this problem by improving care coordination and transitions among high-risk patients.

Case Study

The Cincinnati Children's Hospital Medical Center’s Asthma Improvement Collaborative: Enhancing Quality and Coordination of Care

January 23, 2013 - Building on earlier initiatives, Cincinnati Children’s Hospital Medical Center launched an Asthma Improvement Collaborative in 2008 to enhance the quality and coordination of asthma care for low-income, Medicaid-insured children in Hamilton County, Ohio.

Case Study

The Visiting Nurse Service of New York's Choice Health Plans: Continuous Care Management for Dually Eligible Medicare and Medicaid Beneficiaries

January 23, 2013 - This case study describes how a large nonprofit home health care provider created health plans to serve this population and, in particular, how its customized care management approach has led to reductions in hospitalizations and readmissions.

Case Study

University of California, San Francisco Medical Center: Reducing Readmissions Through Heart Failure Care Management

November 14, 2012 - In 2008, the University of California, San Francisco (UCSF) Medical Center embarked on a grant-funded program to reduce hospital readmissions for elderly patients with heart failure. This case study examines the factors that contributed to its success.

Case Study

Dual Eligible Demonstrations: Resources for Advocates

May 22, 2012 - A new Commonwealth Fund–supported Web site offers educational resources for consumer groups and can serve as a platform for sharing ideas and strategies for improving care for dual eligibles.

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Defining and Measuring Person-Centered Care in Assisted Living

February 27, 2012 - The Centers for Medicare and Medicaid Services (CMS) is in the process of identifying person-centered attributes and indicators for its Medicaid home and community-based services programs. To assist CMS and assisted living stakeholders, the Center for Excellence in Assisted Living, a nonprofit collaborative of 11 national organizations, has published recommendations for person-centered HCBS attributes and assisted living indicators.

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Norton Healthcare: A Strong Payer-Provider Partnership for the Journey to Accountable Care

January 27, 2012 - This case study explores the characteristics of Norton and its partners, including the insurer Humana, that have contributed to the development of the ACO, including: a strong payer–provider relationship bolstered by a joint ACO implementation committee, a focus on performance measurement and reporting, an expanding heath information technology infrastructure, and an integrated system that facilitates communication and collaboration across the continuum of care.

Case Study

Monarch HealthCare: Leveraging Experience in Population Health Management to Attain Accountable Care

January 27, 2012 - Monarch HealthCare, a physician-led independent practice association in Orange County, Calif., is one of the provider groups participating in the Brookings–Dartmouth ACO Pilot Program to form accountable care organizations, which assume responsibility for improving patient care and lowering total costs and, in turn, share in the savings achieved.

Case Study