2 min read
Examining one year of transitional care management
When it comes to hospital discharges, going home ought to mean staying home. As a geriatrician, I’ve learned that the largest gaps in care often occur in those first few days and weeks after being discharged from a hospital or rehabilitation facility. Too often, providers lose track of patients once they are discharged from a hospital, only to see them back there within a month or two.
Topics: SDOH Value-based care Return to Home
3 min read
Addressing social determinants begins with data
New CMS rule supports standardization of data to better understand drivers of health
Topics: Medicare Advantage SDOH
7 min read
Time well spent: Up to one hour to better outcomes with an in-home health evaluation
Time has a special meaning in geriatrics, for both patients and the geriatricians like me that treat them. Older patients are focused on maintaining their function and independence so they can enjoy every day-week-month as happily and healthily as they can. Geriatricians know that to achieve those goals, we need time to connect with patients on both a personal and professional level. Doctors have traditionally been lucky to spend even 15 minutes with their patients — just enough time to cover the chief complaint and maybe some chronic disease basics.
Topics: Medicare Advantage SDOH Value-based care Healthy aging
4 min read
ConnectAbility: Lifting up those with life-altering injuries
Twelve-year-old Sophia’s life changed dramatically when she suffered a traumatic brain injury and stroke after a horrible car accident. She spent 109 days in the hospital, fighting for her life. When she was finally released to go home, she and her family faced a long, difficult recovery journey —Sophia had to relearn the basic skills necessary to help her reclaim her life.
3 min read
Time for a Change of Heart
Each February, the healthcare community rallies to raise awareness around heart healthy behaviors and the importance of regular screenings. When there isn’t a pandemic, we are doing heart walks, wearing red to work, and volunteering at screenings in our communities. Despite the strides forward in prevention and treatment, heart disease remains the leading cause of death (outside of COVID-19) among high-income countries, and is projected to be the leading cause of death worldwide by 2030.