Care Transformation Center Blog

The insights, tools, and resources you need to take on population health management

Use this Medicare tool to pinpoint health disparities in your community

by Helen Wieffering, Praveena Fernes and Tomi Ogundimu May 30, 2019

Provider organizations must bring the same strategic rigor to community health investments as they do to traditional hospital programming. Otherwise, efforts stand to lose leadership buy-in, funding, and momentum before they get off the ground. To make the most of limited resources, provider organizations must take a data-driven approach to identifying target patient populations and community health gaps.

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4 steps to develop a successful Hospital at Home program

by Tomi Ogundimu and Clare Wirth May 28, 2019

Editor's note: A version of this post previously ran in the Daily Briefing.

Systems view Hospital at Home (HaH) with renewed enthusiasm. These programs can improve patient satisfaction and total cost of care. CMS may approve HaH as an alternative payment model under MACRA, making it more financially feasible.

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Want to help your patients lose weight? 3 reasons why commercial diet programs alone won't cut it.

by Abby Burns and Tomi Ogundimu May 22, 2019

Editor's note: This story was updated on May 28, 2019.

The health effects of being overweight or obese have been well studied, but adults in the United States currently weigh more than they have at any point since 1999. However, while providers often seek out methods to help patients address their underlying weight issues in order to treat their presenting conditions, few providers actually offer their patients distinct weight management services. Faced with an endless list of competing priorities and a market saturated with commercial weight-loss programs, providers may be tempted to outsource this service to the Jenny Craigs or Atkins Incs of the world.

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Want to cut Medicaid ED visits? Start with ambulatory care access—here's how.

by Hamza Hasan and Clare Wirth May 8, 2019

Editor's note: A version of this post previously ran on Practice Notes.

According to the CDC's latest data release, ED visits hit a record high in 2016. Patients covered by Medicaid and other state-based programs make up 38% of the 146 million visits across the United States—the highest of any payer type.

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How this Georgia organization used telehealth to cut the pre-term birth rate by 50%

by Emily Johnson, Samara Ford, and Abby Burns May 2, 2019

Editor's note: This story was first published on The Growth Channel and has been modified for a care transformation audience.

Maternal mortality rates in the United States continue to rise, even as they decline in other developed nations. Equally alarming are the high rates of pre-term birth and low birth weight infants.

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The 2-step process to revamp your post-acute care transition process

by Clare Wirth and Tomi Ogundimu April 30, 2019

Earlier this month, Center for Medicare and Medicaid Innovation's (CMMI) top deputy Adam Boehler announced he may be looking to a bundled payment model for post-acute care (PAC) to save money and improve care. While actual implementation is far from imminent, CMMI's interest in PAC bundles underscores the opportunity to better manage populations with enhanced acute care-PAC partnerships.

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Your top population health questions from Q1, answered

by Darby Sullivan, Samara Ford, and Tomi Ogundimu April 25, 2019

Across the first quarter of 2019, we received over 200 questions from members through The Expert Center on all aspects of care transformation. In 2018, many of our questions focused on how best to optimize the foundational aspects of population health, from care transitions to palliative care. This year, your peers are increasingly interested in how to effectively manage specialized populations like dual-eligible patients and pediatric behavioral health needs.

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You can't tackle infant mortality without addressing racial disparities. Here's how.

by Abby Burns and Tomi Ogundimu April 18, 2019

In our first post highlighting how providers can reduce infant mortality, we noted that the infant mortality rate in the United States is 5.9 infant deaths per 1,000 births. But when we break it down by demographic groups, the rate for Black infants is nearly double that number at 11.4 deaths per 1,000 births, compared with 4.9 among non-Hispanic white infants. These racial disparities hold for pregnancy outcomes as well: The rate of preterm birth is 14% among Black women, compared with 9% among white women.

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