7. What’s he saying? I sure
hope my wife is getting
this..
No I’m good to
go. Whatever
Blah blah
you say is what blah, blah blah.
we’ll do Doctor Any questions?
Patient
activation
trumps all
What We Learned
11. Community-Based Care Transitions Program
Partnership between hospitals and CBOs
To pay for transitional care activities not currently paid
Intended to pay for existing successful programs
Services to focus on geographically located population
Paid by roster bill from the CBO
The PAM is a required measure (paid for by TA contract)
12. No successful applications first 4 months
Technical assistance available 8/1
Frequent misunderstanding of the program
‘CBO’
Few existing programs with data
13.
14. We know how to systematize
behavior change to avoid hospital
readmisisons
We mostly know who can get paid to
do it
No Community infrastructure We are getting more sophisticated
for achieving common goals about building collective impact
But we’re still not quite there..
15.
16.
17.
18. Policy is necessary but might be insufficient
19. “It’s clear that somebody has to do
something and it’s incredibly pathetic
that it has to be us.”
Jerry Garcia