Reducing heart failure readmissions required an organized, comprehensive approach at Mary Washington Hospital.

Sakakawea Medical Center and Coal Country Community Health Center worked to improve their continuous care model to ensure patients consistently received warm hand-offs.

Illinois Valley Community Hospital implemented a program combining elements of the Coleman and Naylor models.

Saline Memorial Hospital focused on improving communication, education and daily reporting to reduce readmissions.

Aledade Delaware ACO developed a population health management tool to more effectively coordinate care.

Alliant Quality leverages community partnerships to engage patients in diabetes self-management.

Care coordination helps lower the incidence of anticoagulant-related adverse events among Centura Health Medicare patients.

Greenbriar Community Care Center’s re-hospitalization numbers decreased following data-driven interventions.

The Cancer Center at Presbyterian Hospital initiated quality-of-life care planning to improve the patient care transition experience.

The development of a comprehensive chronic disease management program can significantly improve a patient’s quality of life.