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Collaborating to Reduce Hospital Re-admissions for Older Adults with Complex Needs: Eastern Virginia Care Transitions Partnership
Case Study

Collaborating to Reduce Hospital Readmissions for Older Adults With Complex Needs: Eastern Virginia Care Transitions Partnership

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This case study features The Eastern Virginia Care Transitions Partnership (EVCTP), which includes more than 80 health care and social services organizations and is designed to reduce hospital readmissions and improve quality of care among older adults and those with complex illness through an evidence-based care transition model and in-home assessments.

This unique collaborative effort is a large-scale partnership including Bay Aging and four other Area Agencies on Aging, four health systems, three managed care organizations, and other health care and human service providers.

From February 2013 to January 2015, EVCTP reduced 30-day readmission rate from 18.2 to 8.9 percent, resulting in estimated savings of more than $17M through 1,804 avoided readmissions.


With support from the Robert Wood Johnson Foundation, the Partnership for Healthy Outcomes brought together Nonprofit Finance Fund, the Center for Health Care Strategies, and the Alliance for Strong Families and Communities to capture and share insights for partnerships between health care organizations and community-based organizations (CBOs), particularly those that serve low-income and/or vulnerable populations. This case study series highlights four partnerships illustrating diverse models between CBOs and health care organizations.

Components of Alignment

Data Icon Data
Financing Icon Financing
Governance Icon Governance
Shared Purpose Icon Shared Purpose

Author Organization

Nonprofit Finance Fund, Center for Health Care Strategies, Alliance for Strong Families and Communities

Publication Date

10.2017

Topic Area

Complex Care
Health Care
Social Needs
Webinar

Aligning in Crisis: Strategies and Tools to Leverage Federal Funding

On 9/14, experts from Aligning in Crisis, with support from the Robert Wood Johnson Foundation, will discussed how, if deployed strategically and effectively, federal funds can advance equity, shift power to the community, and set the stage for positive, long-term change.

Webinar

Welcome to the TEAM: A Toolkit for Everyone Aligning and Measuring

This webinar presents the Toolkit for Everyone Aligning and Measuring (TEAM), a tool designed to help people think about measurement and strategy in their cross-sector health collaboratives.

Brief

Intermediary Organizations Are Urgently Needed to Assist in Modernizing Public Health and Addressing the Drivers of Health in the United States

This issue brief describes the different roles intermediaries can play; provides examples of where they have been used in practice; and identifies the risks, benefits, and possible innovations of intermediaries as well as policy approaches that might facilitate their appropriate use.

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