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Care Navigation | Care Transformation Framework: Linking Care to Community
Care navigators can help facilitate transitions as patients — particularly those with chronic or complex diseases — move from the acute care to home setting while remaining connected to needed outpatient services.
AONL-AHA Model of Care Learning Community
This care model innovation learning community aims to enhance collaboration, knowledge sharing, and capacity building among organizations.
Patient and Community Engagement | Care Transformation Framework: Linking Care to Community
Through formal and informal processes (e.g., community health needs assessments, patient and family advisory councils, community-based programs, partnerships) hospitals receive guidance on how they can better connect with individuals of all backgrounds.
Behavioral Health: Community Partnerships
The resources on this page showcase stories and the steps to achieving successful behavioral health community partnerships and expand access to behavioral health services at the right time, place and level of care.
Telehealth Resources | Care Transformation Framework: Community Settings
Telehealth programs expand access to care so that people can conveniently receive medical advice and treatment no matter where they are located.
Provider Partnerships | Care Transformation Framework: Linking Care to Community
By fostering partnerships across providers as part of a clinically integrated network, health care organizations can better facilitate coordinated care for their patients.
Primary Care Transformation | Care Transformation Framework: Linking Care to Community
Health systems are transforming primary care to provide holistic care that closes care gaps while prioritizing prevention and managing complex health and social needs across the continuum of care in alignment with new payment models.
A Sanford Health doctor takes to the skies to bridge the rural health care gap in South Dakota
Storks delivering babies may be a flight of fancy, but a real South Dakota maternal-fetal medicine specialist flies hundreds of miles each week to reach rural patients who would otherwise face hours-long drives for specialized care.
Rankin County Hospital District | Texas: Swing Bed Program Helps Patients Get Continuing Care in Their Community
Rankin County Hospital District (RCHD) supports a “swing bed” program designed specifically for transitional care provided in rural and critical access hospitals, allowing patients to move from acute care to skilled nursing and rehabilitation services within the same facility.
Integrating Behavioral Health: A Path to Whole-Person Care
Mental and physical health are intertwined — this has long been established. One way of transforming the way we approach care delivery is to provide whole-person care through the integration of behavioral and physical health. Integrated care takes systemic coordination and can be complex. In this webinar, learn from two hospitals who are integrating behavioral and physical health in their care delivery.